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ABSTRACT: We tested the effectiveness of a culturally tailored, behavioral theory-based community health worker intervention for improving glycemic control.
We used a randomized, 6-month delayed control group design among 164 African American and Latino adult participants recruited from 2 health systems in Detroit, Michigan. Our study was guided by the principles of community-based participatory research. Hemoglobin A1c (HbA1c) level was the primary outcome measure. Using an empowerment-based approach, community health workers provided participants with diabetes self-management education and regular home visits, and accompanied them to a clinic visit during the 6-month intervention period.
Participants in the intervention group had a mean HbA1c value of 8.6% at baseline, which improved to a value of 7.8% at 6 months, for an adjusted change of -0.8 percentage points (P < .01). There was no change in mean HbA1c among the control group (8.5%). Intervention participants also had significantly greater improvements in self-reported diabetes understanding compared with the control group.
This study contributes to the growing evidence for the effectiveness of community health workers and their role in multidisciplinary teams engaged in culturally appropriate health care delivery.
American Journal of Public Health 06/2011; 101(12):2253-60. · 3.93 Impact Factor
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ABSTRACT: Community health workers (CHWs) play a vital and unique role in linking diverse and underserved populations to health and social service systems. Despite their effectiveness, as documented by empirical studies across various disciplines including public health, nursing, and biomedicine, the value and potential role of CHWs in the social work practice and research literature has been largely absent. Thus, this article introduces social workers to CHWs, their role in promoting culturally appropriate practice, and their utility in collaboration with social workers in community settings. This integrative review also discusses current challenges identified by the CHW literature, including potential barriers to the expansion of CHW programs, as well as issues of training, certification, and sustainability. The review also discusses the close alignment of CHWs with social work values and principles of social justice, suggesting opportunities for enhanced social work practice and research.
Social work 04/2010; 55(2):169-80. · 1.15 Impact Factor
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ABSTRACT: The specific ways in which community health worker (CHW) programs affect participants' healthcare behaviors and interactions with their healthcare providers, as well as mechanisms by which CHW programs influence these outcomes, are poorly understood. A qualitative descriptive study of participants in a successful CHW diabetes self-management program was designed to examine: (1) what gaps in diabetes care, with a focus on patient-doctor interactions, participants identify; (2) how the program influences participants' diabetes care and interactions with healthcare providers, and what gaps, if any, it addresses.
From November 2005 to December 2006, semi-structured interviews with 40 African- American and Latino adults were conducted and analyzed. Participants had diabetes and had completed or were active in a CHW-led diabetes self-management program developed and implemented using community-based participatory research principles in Detroit. Interviews were audiotaped, transcribed, and coded through a consensual and iterative process.
Participants reported that prior to the intervention they had received inadequate information from healthcare providers for effective diabetes self-management, had had low expectations for help from their providers, and had not felt comfortable asking questions or making requests of their healthcare providers. Key ways participants reported that the program improved their ability to manage their diabetes were by providing (1) clear and detailed information on diabetes and diabetes care; (2) education and training on specific strategies to meet diabetes care goals; (3) sustained and nonjudgmental assistance to increase their motivation and confidence; and (4) social and peer support that enabled them to better manage their diabetes. The knowledge and confidence gained through the CHW intervention increased participants' assertiveness in asking questions to and requesting necessary tests and results from their providers.
Study findings suggest ways that CHW programs that provide both one-on-one support and group self-management training sessions may be effective in promoting more effective diabetes care and patient-doctor relationships among Latino and African-American adults with diabetes. Through these mechanisms, such interventions may help to mitigate racial and ethnic disparities in diabetes care and outcomes.
American journal of preventive medicine 12/2009; 37(6 Suppl 1):S270-9. · 4.24 Impact Factor
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ABSTRACT: Family support is important in diabetes self-management. However, children as providers of support have received little attention. This study examines the role of children in their parents' diabetes self-management, diet, and exercise.
This research used community-based participatory research principles. Researchers conducted semi-structured parallel interviews of 24 Latino and African-American adults with diabetes and with a child (aged 10-17 years) in their home (2004-2006). Interviews were transcribed, coded, and analyzed for themes (2004-2007).
Adults and children perceived that children play many roles related to adults' diabetes self-management. Parents described children as monitoring parents' dietary intake and reminding them what they should not be eating. Some children helped with shopping and meal preparation. Families described children reminding parents to exercise and exercising with their parents. Children reminded parents about medications and assisted with tasks such as checking blood sugar. Parents and children perceived that children played a role in tempting parents to stray from their diabetes diet, because children's diets included food that parents desired but tried to avoid.
Children and parents perceived that children have many roles in both supporting and undermining adults' diabetes self-management. There is more to learn about the bi-directional relationships between adults and children in this setting, and the most beneficial roles children can play. Healthcare providers should encourage family lifestyle changes, strengthen social support for families, and direct children toward roles that are beneficial for both parent and child without placing an unreasonable level of responsibility on the child.
American journal of preventive medicine 12/2009; 37(6 Suppl 1):S251-61. · 4.24 Impact Factor
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ABSTRACT: Social support is associated with better diabetes self-management behavior (SMB), yet interventions to increase family and friend support (FF support) have had inconsistent effects on SMB.
To test whether FF support differentially affects specific SMBs and compare the influence of support from health professionals and psychological factors on specific SMBs to that of FF support.
Cross-sectional survey of people with diabetes recruited for a self-management intervention
One hundred sixty-four African-American and Latino adults with diabetes living in inner-city Detroit
For every unit increase in FF support for glucose monitoring, the adjusted odds ratio (AOR) of completing testing as recommended was 1.77 (95% CI 1.21-2.58). FF support was not associated with four other SMBs (taking medicines, following a meal plan, physical activity, checking feet). Support from non-physician health professionals was associated with checking feet [AOR 1.72 (1.07-2.78)] and meal plan adherence [AOR = 1.61 (1.11-2.34)]. Diabetes self-efficacy was associated with testing sugar, meal plan adherence, and checking feet. Additional analyses suggested that self-efficacy was mediating the effect of FF support on diet and checking feet, but not the FF support effect on glucose monitoring.
The association between FF support and SMB performance was stronger for glucose monitoring than for other SMBs. Professional support and diabetes self-efficacy were each independently associated with performance of different SMBs. SMB interventions may need to differentially emphasize FF support, self-efficacy, or professional support depending on the SMB targeted for improvement.
Journal of General Internal Medicine 11/2008; 23(12):1992-9. · 2.83 Impact Factor
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ABSTRACT: Among adults with diabetes attempting to change their own diets, we explored how these adults approached providing food for their children and how their children reacted to dietary changes in the household.
The research design used semi-structured parallel individual interviews of adults and a child (aged 10-17 years) in their home. Interviews were audio-taped, transcribed, coded and analysed for themes.
Subjects included families in which one inner-city African American or Latino adult with diabetes had completed a diabetes intervention promoting healthy dietary behaviours.
We completed 29 interviews (14 adult-child pairs and one child). Adults approached making dietary changes for themselves and also providing food for their family in different ways, ranging from expecting everyone to eat the same thing to preparing two separate meals. Many children resisted dietary changes while fewer acquiesced. Among children who went along with changes, some reported resisting initially then adjusting, while others did not resist because the food still tasted good or they could obtain preferred foods outside the house. The intersection of adults' meal strategies and children's reactions to the changes can be used to categorise families into different patterns. These patterns highlight the tension between an adult who must make dietary changes to control diabetes and a child who is not necessarily motivated to change.
From this framework we suggest hypotheses about how these patterns might influence dietary behaviour in adults and children. Understanding these patterns could guide interventions to assist parents in successfully including children in their dietary changes.
Public Health Nutrition 05/2008; 11(4):427-36. · 2.17 Impact Factor
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ABSTRACT: To compare chronic disease risk factors and their correlates for African American and Hispanic residents of REACH Detroit, Michigan, and the United States.
Behavioral Risk Factor Survey data from 2001-2003 were used for comparisons and regression models.
Several chronic disease risk factors were more prevalent among REACH Detroit residents than their Michigan and U.S. counterparts. In REACH Detroit, greater fruit and vegetable consumption was associated with more than high school education and older age among Hispanics, and meeting exercise guidelines and older age among African Americans. Less than high school education, smoking, and male gender were associated with lower consumption among African Americans. Greater physical activity was associated with younger age, male gender, and more fruit and vegetable consumption among African Americans, and unemployment among Hispanics.
Surveillance of health behaviors in high-risk communities contributes to planning interventions and policies for reducing racial and ethnic disparities.
Health Promotion Practice 08/2006; 7(3 Suppl):256S-64S.
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ABSTRACT: This study examines baseline levels and correlates of diabetes-related emotional distress among inner-city African Americans and Hispanics with type 2 diabetes. The Problem Areas in Diabetes (PAID) scale, which measures diabetes-related emotional distress, was administered to 180 African American and Hispanic adults participating in the REACH Detroit Partnership. We examined bivariate and multivariate associations between emotional distress and biological, psychosocial, and quality of health care variables for African Americans and Hispanics. Scores were significantly higher among Hispanics than African Americans. Demographic factors were stronger predictors of emotional distress for Hispanics than for African Americans. Daily hassles, physician support, and perceived seriousness and understanding of diabetes were significant for African Americans. Understanding the personal, family and community context of living with diabetes and conducting interventions that provide support and coping strategies for self-management have important implications for reducing health disparities among disadvantaged racial and ethnic groups.
Journal of Health Care for the Poor and Underserved 06/2006; 17(2 Suppl):88-105. · 1.10 Impact Factor
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Jacqueline Two Feathers,
Edith C Kieffer, Gloria Palmisano,
Mike Anderson,
Brandy Sinco,
Nancy Janz,
Michele Heisler,
Mike Spencer,
Ricardo Guzman,
Janice Thompson,
Kimberlydawn Wisdom,
Sherman A James
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ABSTRACT: We sought to determine the effects of a community-based, culturally tailored diabetes lifestyle intervention on risk factors for diabetes complications among African Americans and Latinos with type 2 diabetes.
One hundred fifty-one African American and Latino adults with diabetes were recruited from 3 health care systems in Detroit, Michigan, to participate in the Racial and Ethnic Approaches to Community Health (REACH) Detroit Partnership diabetes lifestyle intervention. The curriculum, delivered by trained community residents, was aimed at improving dietary, physical activity, and diabetes self-care behaviors. Baseline and postintervention levels of diabetes-specific quality-of-life, diet, physical activity, self-care knowledge and behaviors, and hemoglobin A1C were assessed.
There were statistically significant improvements in postintervention dietary knowledge and behaviors and physical activity knowledge. A statistically significant improvement in A1C level was achieved among REACH Detroit program participants (P<.0001) compared with a group of patients with diabetes in the same health care system in which no significant changes were observed (P=.160).
A culturally tailored diabetes lifestyle intervention delivered by trained community residents produced significant improvement in dietary and diabetes self-care related knowledge and behaviors as well as important metabolic improvements.
American Journal of Public Health 10/2005; 95(9):1552-60. · 3.93 Impact Factor
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ABSTRACT: The purpose of this article was to describe the development, implementation, and process evaluation findings of a culturally tailored diabetes lifestyle intervention for African Americans and Latinos.
African American and Latino adults with type 2 diabetes from 3 health care systems in Detroit, Michigan, participated in diabetes lifestyle intervention of the Racial and Ethnic Approaches to Community Health Detroit Partnership. The intervention curricula were culturally and linguistically tailored for each population. Trained community residents delivered the curricula in 5 group meetings aimed at improving dietary, physical activity, and diabetes self-care behaviors of study participants. The aims of the process evaluation were to assess participant satisfaction with the intervention, utility, and applicability of information and cultural relevance of intervention materials. Content analysis was used to analyze qualitative data. Matrices were developed along thematic lines, and common themes were determined by grouping responses by question.
Ninety-eight percent of participants attended 1 or more intervention classes; 41% attended all 5 meetings. Attendance rates ranged from 59% to 88% for individual meetings. Participants reported that program information and activities were useful, culturally relevant, and applicable to diabetes self-management. Participants also appreciated the convenient community location for meetings and the social support received from other participants.
A community-based, culturally tailored diabetes lifestyle intervention delivered by trained community residents was associated with high participant satisfaction and retention.
The Diabetes Educator 33(3):509-20. · 1.96 Impact Factor
