Randomized Controlled Trial of a Community Health Worker Self-Management Support Intervention Among Low-Income Adults With Diabetes, Seattle, Washington, 2010-2014.

Karin Nelson,Meghan Kiefer,Dan Lessler,Leslie Taylor,Paul Hebert,James Krieger,Julie Silverman

doi:10.5888/pcd14.160344

Abstract

IntroductionCommunity health workers (CHWs) can improve diabetes outcomes; however, questions remain about translating research findings into practical low-intensity models for safety-net providers. We tested the effectiveness of a home-based low-intensity CHW intervention for improving health outcomes among low-income adults with diabetes.MethodsLow-income patients with glycated hemoglobin A1c (HbA1c) of 8.0% or higher in the 12 months before enrollment from 3 safety-net providers were randomized to a 12-month CHW-delivered diabetes self-management intervention or usual care. CHWs were based at a local health department. The primary outcome was change in HbA1c from baseline enrollment to 12 months; secondary outcomes included blood pressure and lipid levels, quality of life, and health care use.ResultsThe change in HbA1c in the intervention group (n = 145) (unadjusted mean of 9.09% to 8.58%, change of −0.51) compared with the control group (n = 142) (9.04% to 8.71%, change of −0.33) was not significant (P = .54). In an analysis of participants with poor glycemic control (HbA1c >10%), the intervention group had a 1.23-point greater decrease in HbA1c compared with controls (P = .046). For the entire study population, we found a decrease in reported physician visits (P < .001) and no improvement in health-related quality of life (P = .07) in the intervention group compared with the control group.ConclusionA low-intensity CHW-delivered intervention to support diabetes self-management did not significantly improve HbA1c relative to usual care. Among the subgroup of participants with poor glycemic control (HbA1c >10% at baseline), the intervention was effective.

Highlights

Community health workers (CHWs) can improve diabetes outcomes; questions remain about translating research findings into practical low-intensity models for safety-net providers
We found no differences between the intervention and control groups in baseline blood pressure or lipid levels or in the number of outpatient clinic visits or emergency department encounters (Table 2)
We found no change in hemoglobin A1c (HbA1c) values in the intervention group compared with the control group (P = .54)

Summary

Introduction

Community health workers (CHWs) can improve diabetes outcomes; questions remain about translating research findings into practical low-intensity models for safety-net providers. We tested the effectiveness of a home-based low-intensity CHW intervention for improving health outcomes among low-income adults with diabetes. Low-income and racial/ethnic minority populations have a high disease burden [1]. Using community health workers (CHWs) may be an effective approach with disadvantaged populations [3,4]. A recent meta-analysis reported modest effects for CHW interventions for patients with diabetes [3]. Many previous studies were conducted in single sites or targeted racial or ethnic minority groups. Studies varied widely in the intensity of the CHW intervention, with visit frequencies ranging from 4 to 36 [3]

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Results

Conclusion