Effectiveness of community health workers in the care of persons with diabetes

Norris, Susan L.; Chowdhury, Farah M.; Le, Khanh; Horsley, Tanya; Brownstein, J. Nell; Zhang, X.; Jack, Leonard; Satterfield, Dawn

doi:10.1111/j.1464-5491.2006.01845.x

Cited by 367 publications

(338 citation statements)

References 38 publications

(97 reference statements)

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“…13,19,20,[22][23][24]26,27,[57][58][59][60] Studies with Mexican Americans with diabetes utilizing peer-led diabetes self-management interventions have found improvements in glucose control. 22,23,[25][26][27] There is still a need for ongoing work to understand what training is required and the qualities that enable a person to become an effective peer leader in Latino communities.…”

Section: Discussionmentioning

confidence: 99%

Picture Good Health: A Church-Based Self-Management Intervention Among Latino Adults with Diabetes

et al. 2015

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BACKGROUND: Churches may provide a familiar and accessible setting for chronic disease self-management education and social support for Latinos with diabetes. OBJECTIVE: We assessed the impact of a multi-faceted church-based diabetes self-management intervention on diabetes outcomes among Latino adults. DESIGN: This was a community-based, randomized controlled, pilot study. SUBJECTS: One-hundred adults with self-reported diabetes from a Midwestern, urban, low-income MexicanAmerican neighborhood were included in the study. INTERVENTIONS: Intervention participants were enrolled in a church-based diabetes self-management program that included eight weekly group classes led by trained lay leaders. Enhanced usual care participants attended one 90-minute lecture on diabetes selfmanagement at a local church. OUTCOME MEASURES: The primary outcome was change in glycosylated hemoglobin (A1C). Secondary outcomes included changes in low-density lipoproteins (LDL), blood pressure, weight, and diabetes self-care practices. KEY RESULTS: Participants' mean age was 54±12 years, 81 % were female, 98 % were Latino, and 51 % were uninsured. At 3 months, study participants in both arms decreased their A1C from baseline (−0.32 %, 95 % confidence interval [CI]: -0.62, -0.02 %). The difference in change in A1C, LDL, blood pressure and weight from baseline to 3-month and 6-month follow-up was not statistically significant between the intervention and enhanced usual care groups. Intervention participants

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Section: Discussionmentioning

confidence: 99%

Picture Good Health: A Church-Based Self-Management Intervention Among Latino Adults with Diabetes

et al. 2015

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“…Staten et al 80 argued that questionable competency levels of CBHWs prior to studies and variability in fidelity of CBHW intervention implementation could be possible explanations for nonsignificant effects found in some studies. Previous systematic reviews 17,19 underscored the importance of required training and competency levels in relation to assigned responsibilities. Limited yet growing research has focused on the degree to which CBHWs can achieve their competency levels to serve successfully as an interventionist in vulnerable populations.…”

Section: Discussionmentioning

confidence: 99%

Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review

Kim¹,

Choi²,

Choi³

et al. 2016

Am J Public Health

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“…In order to capture the breadth of CHW job titles, we drew search terms from: (1) previous systematic reviews on CHWs, 8,[20][21][22] (2) specific job titles used for CHWs in Massachusetts, based on a survey of CHW programs conducted by the Massachusetts Department of Public Health, 23,24 and (3) additional terms on health coaching and doulas, some of which were added after consulting with staff at the Massachusetts Department of Public Health's Office of CHWs. Massachusetts is one of two states 25 with an office of CHWs and has a range of CHW programs, making the list of job titles broad.…”

Section: Search Strategymentioning

confidence: 99%

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

et al. 2016

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BACKGROUND: As the US transitions to value-based healthcare, physicians and payers are incentivized to change healthcare delivery to improve quality of care while controlling costs. By assisting with the management of common chronic conditions, community health workers (CHWs) may improve healthcare quality, but physicians and payers who are making choices about care delivery also need to understand their effects on healthcare spending. METHODS: We searched PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PsycINFO, Embase, and Web of Science from the inception of each database to 22 June 2015. We included US-based studies that evaluated a CHW intervention for patients with at least one chronic health condition and reported cost or healthcare utilization outcomes. We evaluated studies using tools specific to study design. RESULTS: Our search yielded 2,941 studies after removing duplicates. Thirty-four met inclusion and methodological criteria. Sixteen studies (47%) were randomized controlled trials (RCTs). RCTs typically had less positive outcomes than other study designs. Of the 16 RCTs, 12 reported utilization outcomes, of which 5 showed a significant reduction in one or more of ED visits, hospitalizations and/or urgent care visits. Significant reductions reported in ED visits ranged from 23%-51% and in hospitalizations ranged from 21%-50%, and the one significant reduction in urgent care visits was recorded at 60% (p < 0.05 for all). DISCUSSION: Our results suggest that CHW interventions have variable effects, but some may reduce costs and preventable utilization. These findings suggest that it is possible to achieve reductions in care utilization and cost savings by integrating CHWs into chronic care management. However, variations in cost and utilization outcomes suggest that CHWs alone do not make an intervention successful. The paucity of rigorous studies and heterogeneity of study designs limited conclusions about factors associated with reduced utilization.

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Effectiveness of community health workers in the care of persons with diabetes

Cited by 367 publications

References 38 publications

Picture Good Health: A Church-Based Self-Management Intervention Among Latino Adults with Diabetes

Picture Good Health: A Church-Based Self-Management Intervention Among Latino Adults with Diabetes

Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

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