Mexican American Trial of Community Health Workers: A Randomized Controlled Trial of a Community Health Worker Intervention for Mexican Americans With Type 2 Diabetes Mellitus

Abstract

Objectives. We assessed whether community health workers (CHWs) could improve glycemic control among Mexican Americans with diabetes. Methods. We recruited 144 Mexican Americans with type 2 diabetes between January 2006 and September 2008 into the single-blinded, randomized controlled Mexican American Trial of Community Health Workers (MATCH) and followed them for 2 years. Participants were assigned to either a CHW intervention, delivering self-management training through 36 home visits over 2 years, or a bilingual control newsletter delivering the same information on the same schedule. Results. Intervention participants showed significantly lower hemoglobin A1c levels than control participants at both year 1 Δ = −0.55; P = .021) and year 2 (Δ = −0.69; P = .005). We observed no effect on blood pressure control, glucose self-monitoring, or adherence to medications or diet. Intervention participants increased physical activity from a mean of 1.63 days per week at baseline to 2.64 days per week after 2 years. Conclusions. A self-management intervention delivered by CHWs resulted in sustained improvements in glycemic control over 2 years among Mexican Americans with diabetes. MATCH adds to the growing body of evidence supporting the use of CHWs to reduce diabetes-related health disparities.

Community Health Worker Interventions to Improve Glycemic Control in People with Diabetes: A Systematic Review and Meta-Analysis

“…[8][9][10][11][12][13][14][19][20][21][22][23][24] Table 1 describes the basic characteristics of those thirteen trials, including the setting for participant recruitment, duration of the study, and ethnicity of the study populations. Most of them studied minority populations, either AfricanAmerican, 13 Hispanics, 9,10,12,14,19,21,23,24 or both. 8 Allen et al recruited some White participants (21 % of their study sample), but the majority of their participants were AfricanAmerican.…”

“…In the two-year-long MATCH study, participants in the control arm were mailed 36 monthly issues of a diabetes education newsletter. 12,14 Finally, the design of the study by Tang et al merits particular attention, because it deviates from the approach of comparing the CHW intervention to usual care. 24 In that study, all participants first received a 6-month diabetes self-management education program.…”

“…Finally, only one study reported community outreach activities as a component of the intervention. 12 With regard to the training CHWs received, the approach taken in certain studies is noteworthy, as it may provide a template for clinical implementation. For example, in the study by Prezio et al, the CHW was professionally certified by the state of Texas, and received 27 hours of additional instruction from Certified Diabetes Educators, Registered Dietitians, and an endocrinologist.…”

“…In the MATCH (Mexican American Trial of Community Health Workers) study, the CHWs underwent stepwise training in Spanish. 12 The initial phase consisted of a brief review of CHW practice, formal training on diabetes knowledge, and project-specific training on self-management and home visiting. The diabetes knowledge component required 24 hours of face-to-face training, and culminated in a written test assessing knowledge of diabetes self-management.…”

“…Randomized controlled trials have had conflicting results. Some trials showed a significant reduction in A1c, [8][9][10][11][12] while other trials did not. 13,14 Of note, there was methodological variability across studies, including sample size, target population, intervention protocols, and length of follow-up.…”