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

Details

• Journal Article:
  Preventing Chronic Disease (PCD)
• Personal Author:
  Nelson, Karin ; Taylor, Leslie ; Silverman, Julie ; Kiefer, Meghan ; Hebert, Paul ; Lessler, Dan ; Krieger, James
• Description:
  Introduction
  
  Community 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.
  
  Methods
  
  Low-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.
  
  Results
  
  The 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.
  
  Conclusion
  
  A 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.
  
  
• Subjects:
  Adult Aged Community Health Workers Diabetes Mellitus Female Humans Male Middle Aged Poverty Self-Management
• Source:
  Prev Chronic Dis. 14.
• DOI:
  http://dx.doi.org/10.5888/pcd14.160344
• ISSN:
  1545-1151
• Pubmed ID:
  28182863
• Pubmed Central ID:
  PMC5303652
• Document Type:
  Journal Article
• Funding:
  R18 DK088072/DK/NIDDK NIH HHS/United States
• Place as Subject:
  Washington
• Volume:
  14
• Collection(s):
  Preventing Chronic Disease
• Main Document Checksum:
  urn:sha-512:a9ad88ab55179c45eebb9e7ec765c72dfbe2a16383d7dea2caefc714e2060f320cedbbe7c00fa927c589951aec0747819036b056e97ad79a6fd0dd64c46ad66b
• Download URL:
  https://stacks.cdc.gov/view/cdc/44186/cdc_44186_DS1.pdf
• File Type:
  [PDF - 375.64 KB ]