Impact of a community-based approach to patient engagement in rural, low-income adults with type 2 diabetes.

Abstract

This secondary analysis examined the relationships between Patient Activation Measure (PAM) scores, use of health services, and HgA1C. A feasibility study was conducted for a community-based intervention for high-risk adults with uncontrolled diabetes. Data were collected at baseline and monthly, including PAM and modified Diabetes Self-Management Assessment Report Tool. Participants (n=58) were randomized to a 3-month nurse (RN) telephone management or community health worker (CHW) in-home intervention, focusing on medication adherence, timely follow-up, diabetes self-management coaching, and linkage to resources. Sample was mostly female (73%), African-American (90%), low income (75%), high school education or less (80%), and mean age of 59years. A positive association between PAM score and self-reported diabetes care recommendations was found (r=.356, p=.014) and significant correlation between baseline PAM score and HgA1C levels (r=-.306, p=.029). A paired samples t test showed statistically significant increases in PAM scores in the CHW intervention group (mean increase +8.5, CI [+2.49 to +14.65]); baseline (M=60.31, SD=13.3) to end of study ([M=68.89, SD=16.39], t(22)=2.924, p=.008 [two-tailed]). A community-based approach to diabetes management demonstrated a positive effect on patient activation. Although disparities in health care access among rural, low-income populations exist, community-based interventions show potential for improving patient engagement in diabetes management and recommended health services.