The Impact of Promotoras on Social Support and Glycemic Control Among Members of a Farmworker Community on the US-Mexico Border

Mel and End Zuckerman College of Public Health, University of Arizona, PO Box 245163, Tucson, AZ 85724, USA.
The Diabetes Educator (Impact Factor: 1.79). 07/2007; 33 Suppl 6(Supplement 6):172S-178S. DOI: 10.1177/0145721707304170
Source: PubMed

ABSTRACT The purpose of this study is to describe the effect of a promotora-driven intervention to build social support as a means to affect self-management behaviors and clinical outcomes in a farmworker community on the US-Mexico border.
Promotoras implemented a community-based intervention that included support groups, home/hospital visits, telephone support, and advocacy to people with diabetes. A 12-month pre/post study design was used to investigate the relationship between promotora contact, perceived support, and clinical outcomes. Clinical data were gathered from 70 participants during routine physician visits. A pre/post questionnaire was used to measure perceived support and self-management practices.
Glycosylated hemoglobin (HbA1c) levels decreased 1% among high-risk participants. Improved HbA1c level was associated with promotora advocacy and participation in promotora-led support groups. Participants reported increased support from family and friends and more comfort speaking about diabetes (la enfermedad) with family and friends.
These findings document improvement in both clinical and social health indicators for Mexican Americans in a farmworker community when a promotora model is used to provide and facilitate culturally relevant support for diabetes self-management practices.

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Available from: Maia Ingram, May 15, 2014
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    • "The present study is one of the first to show the efficacy of using CHWs to implement successful active living and healthy eating interventions among a pediatric population as well as adding to growing literature that demonstrates the effective use of CHWs among persons living in low income communities to promote health and disease management strategies [18]-[20]. Our study is subject to the limitations of participants serving as their own controls; hence issues of self-selection and generalizability may exist. "
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    ABSTRACT: The promotion of physical activity and healthy eating to prevent obesity among youth is a pressing challenge. The current study examined the feasibility of community health workers (CHWs) con-ducting a physical activity (PA) and healthy eating intervention strategy with links to community supports and programs. Youth aged 10 -18 years were recruited from three clinical sites serving inner-city families. Trained CHWs conducted assessment and counseling for PA and healthy eating among youth and their families and provided customized plans and navigation to neighborhood PA and nutrition programs. Measures of daily PA by self-report, weekday and weekend day se-dentary behaviors, fruit and vegetable intake, avoidance of fatty foods, and avoidance of sugary drinks were assessed at baseline and follow-up. Twenty-five patients (mean age = 12.9 years) were exposed to ~9 months of intervention from baseline. Pre-and post-assessments revealed significant changes in reported PA, sedentary behaviors on weekdays, sedentary behaviors on weekend days, fruit and vegetable intake, avoidance of fatty foods, and avoidance of sugary drinks. Results demonstrated the feasibility of having CHWs effectively influenced the PA and eating be-haviors of inner-city youth. Greater success was evident when assessment and counseling for PA and healthy eating were accompanied by navigation to neighborhood resources. The use of CHWs may be a cost-effective approach impacting the PA, sedentary, and dietary behaviors of youth.
    Health 10/2014; 6(17):2342-2348. DOI:10.4236/health.2014.617269 · 0.51 Impact Factor
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    • "Previous studies have reported that the lack of social relationships is a major risk factor for morbidity and mortality, especially among men.24 On the other hand, positive social support has been associated with improved medication, dietary25 and exercise adherence,26 decreased depression,27 smoking cessation,28 good diabetes self-management, and improved clinical outcomes.29 Many similarly encouraging reports have caused greater attention to be paid to the concept of social support, resulting in it becoming a core component of diabetes care in recent years. "
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    ABSTRACT: Coping with type II diabetic patients is increasingly posing large financial burdens, sorely felt especially by growing economies. Self-management has been found to be an effective approach towards maintaining good control in diabetics. However, although efforts at implementing self-management have had initial success, there has been a lack of sustainability. This review examines the different components impinging on self-care among type II diabetic patients. These include the critical role of social support, the need for support from health care providers, the value of support from family and friends, the influence of sex and cultural factors in self-care behavior, the benefits of peer support, and the role of literacy in diabetes self-care. Despite the mounting evidence for the effectiveness of social support in diabetes care, and the various stakeholders including this in their clinical guidelines, there has only been a lukewarm response from policy-makers towards ensuring its implementation. Hence, more effort is required from health care providers in moving away from just understanding the effects of new drugs and subsequently putting their patients on these drugs, and going back to the basics of communicating with the patients, understanding their woes, and helping to motivate/empower their patients. This paper analyzes the various components of social support, their influence on diabetes self-care, and how health care providers can help in this process.
    Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 11/2012; 5:407-17. DOI:10.2147/DMSO.S37183
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    • "CHW interventions improve knowledge about this chronic health condition (12,13), self-management (13–15), and self-efficacy (13). CHW interventions have also resulted in significant reductions in A1c levels (12,13,15,16). Although research has analyzed the cost-effectiveness of CHW-based diabetes management interventions delivered in primary care settings (17,18), we know of no cost-effectiveness studies of diabetes self-care interventions that involve CHWs delivering home-based counseling and education. "
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    ABSTRACT: The objective of our study was to estimate the long-term cost-effectiveness of a lifestyle modification program led by community health workers (CHWs) for low-income Hispanic adults with type 2 diabetes. We forecasted disease outcomes, quality-adjusted life years (QALYs) gained, and lifetime costs associated with attaining different hemoglobin A1c (A1c) levels. Outcomes were projected 20 years into the future and discounted at a 3.0% rate. Sensitivity analyses were conducted to assess the extent to which our results were dependent on assumptions related to program effectiveness, projected years, discount rates, and costs. The incremental cost-effectiveness ratio of the intervention ranged from $10,995 to $33,319 per QALY gained when compared with usual care. The intervention was particularly cost-effective for adults with high glycemic levels (A1c > 9%). The results are robust to changes in multiple parameters. The CHW program was cost-effective. This study adds to the evidence that culturally sensitive lifestyle modification programs to control diabetes can be a cost-effective way to improve health among Hispanics with diabetes, particularly among those with high A1c levels.
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