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Current Diabetes Reports

Erschienen in:

01.04.2013 | Health Care Delivery Systems in Diabetes (D Wexler, Section Editor)

The Role of Community Health Workers in Diabetes: Update on Current Literature

verfasst von: Megha Shah, Elizabeth Kaselitz, Michele Heisler

Erschienen in: Current Diabetes Reports | Ausgabe 2/2013

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Abstract

Community health worker (CHW) interventions have been found to be a promising strategy for improving diabetes outcomes, especially among low-income and racial and ethnic minority populations. This review serves as an update of the literature published since 2011 on CHWs’ role in diabetes care. In our review of the most current literature, we noted several key areas of advancement. These areas include community-based participatory research approaches to intervention development and evaluation, analyses of the cost effectiveness of CHW interventions, evaluation of sustainability through integrated team-based approaches, thorough descriptions of characteristics and training of CHWs, and delineation of the scope of practice and most effective roles for CHWs.

Heisler M, Faul JD, Hayward R, et al. Mechanisms for Racial and Ethnic Disparities in Glycemic Control in Middle-Aged and Older Americans in the Health and Retirement Study. Arch Intern Med. 2007;167(17):1–8.CrossRef

Ruggiero L, Castillo A, Quinn L, Hochwert M. Translation of the diabetes prevention program's lifestyle intervention: role of community health workers. Curr Diab Rep. 2012;12(2):127–37.PubMedCrossRef

APHA: Community Health Workers. http://www.apha.org/membergroups/sections/aphasections/chw/. Accessed November 26, 2012.

•• Norris SL, Chowdhury FM, Van Le K, et al. Effectiveness of community health workers in the care of persons with diabetes. Diabet Med. 2006;23(5):544–56. This systematic review of CHWs in diabetes care identified five main roles of CHWs. Data demonstrated improved knowledge about diabetes, self-monitoring, self-care, and lifestyle changes, but several gaps in the evidence were noted.PubMedCrossRef

• Spencer MS, Rosland AM, Kieffer EC, et al. Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: a randomized controlled trial. Am J Public Health. 2011;101(12):2253–60. This RCT utilized CBPR methods to conduct a rigorous study design of the effects of CHWs for type 2 diabetes. Outcomes included a decrease in HbA1c and improved self-reported diabetes understanding.

• Katula JA, Vitolins MZ, Rosenberger EL, et al. One-year results of a community-based translation of the Diabetes Prevention Program: Healthy-Living Partnerships to Prevent Diabetes (HELP PD) Project. Diabetes Care. 2011;34(7):1451–7. This community-based RCT tested a weight loss intervention led by CHWs with dietitian oversight. Outcomes included improved fasting glucoses and weight loss.

• Allen JK, Himmelfarb CR, Szanton SL, et al. COACH trial: a randomized controlled trial of nurse practitioner/community health worker cardiovascular disease risk reduction in urban community health centers: rationale and design. Contemp Clin Trials. 2011;32(3):403–11. This RCT evaluated a nurse practitioner/CHW integrated team model for cardiovascular disease risk reduction. Outcomes include a significant improvement in total cholesterol, triglycerides, systolic blood pressure, HbA1c and perception of quality of care.

Babamoto KS, Sey KA, Camilleri AJ, et al. Improving diabetes care and health measures among hispanics using community health workers: results from a randomized controlled trial. Health Educ Behav. 2009;36(1):113–26.PubMedCrossRef

Brown SA, Garcia AA, Kouzekanani K, Hanis CL. Culturally competent diabetes self-management education for Mexican Americans: the Starr County border health initiative. Diabetes Care. 2002;25(2):259–68.PubMedCrossRef

10.

Gary TL, Bone LR, Hill MN, et al. Randomized controlled trial of the effects of nurse case manager and community health worker interventions on risk factors for diabetes-related complications in urban African Americans. Prev Med. 2003;37(1):23–32.PubMedCrossRef

11.

Thompson JR, Horton C, Flores C. Advancing diabetes self-management in the Mexican American population: a community health worker model in a primary care setting. Diabetes Educ. 2007;33 Suppl 6:159S–65S.PubMedCrossRef

12.

Israel BA, Eng E, Schulz A, Parker E. Methods in Community-Based Participatory Research for Health. San Francisco, CA: Jossey-Bass; 2005.

13.

•• Lewin SA, Dick J, Pond P, et al.: Lay health workers in primary and community health care. Cochrane Database Syst Rev 2005(1):CD004015. This review found that scarcity of RCTs of CHW interventions made evidence on the benefits of CHW interventions in diabetes inconclusive. An RCT design strengthens the internal validity of the findings for all aspects of intervention design and implementation.

14.

•• Hunt CW, Grant JS, Appel SJ. An integrative review of community health advisors in type 2 diabetes. J Community Health. 2011;36(5):883–93. This integrative literature review examined the theoretical basis and populations served, as well as characteristics, training, and effectiveness of CHW interventions in diabetes. Many studies (7 out of 16) did not include a theoretical basis for the intervention.PubMedCrossRef

15.

• Ruggiero L, Oros S, Choi YK. Community-based translation of the diabetes prevention program's lifestyle intervention in an underserved Latino population. Diabetes Educ. 2011;37(4):564–72. This study used CBPR methods to deliver the Diabetes Prevention Program (DPP) lifestyle intervention. Outcomes include improved physical activity, dietary scores, BMI and waist circumference. PubMedCrossRef

16.

•• Viswanathan M, Kraschnewski J, Nishikawa B, et al.: Outcomes of community health worker interventions. Evid Rep Technol Assess (Full Rep) 2009(181):1-144, A141-142, B141-114, passim. This systematic review examined characteristics, outcomes cost and cost effectiveness, and training of CHWs. Only nine studies from 1980 to 2008 included information on the actual intervention, outcomes, and cost effectiveness.

17.

• Brown 3rd HS, Wilson KJ, Pagan JA, et al. Cost-effectiveness analysis of a community health worker intervention for low-income Hispanic adults with diabetes. Prev Chronic Dis. 2012;9:E140. This study examined the long-term cost effectiveness of a CHW- led lifestyle intervention using quality-adjusted life years (QALYs). The intervention was found to be cost-effective based on the conventional $50,000 cutoff per QALY in patients with diabetes. PubMedCrossRef

18.

•• Li R, Zhang P, Barker LE, et al. Cost-effectiveness of interventions to prevent and control diabetes mellitus: a systematic review. Diabetes Care. 2010;33(8):1872–94. This systematic review on the cost effectiveness of diabetes prevention and control interventions classified cost effectiveness on the basis of the conventional $50,000 cutoff per QALY gained in diabetic patients. Many diabetes interventions were found to be cost effective or cost saving.PubMedCrossRef

19.

Katula JA, Vitolins MZ, Rosenberger EL, et al. Healthy Living Partnerships to Prevent Diabetes (HELP PD): design and methods. Contemp Clin Trials. 2010;31(1):71–81.PubMedCrossRef

20.

Balcazar H, Rosenthal EL, Brownstein JN, et al. Community health workers can be a public health force for change in the United States: three actions for a new paradigm. Am J Public Health. 2011;101(12):2199–203.PubMedCrossRef

21.

• Hargraves JL, Ferguson WJ, Lemay CA, Pernice J. Community health workers assisting patients with diabetes in self-management. J Ambul Care Manage. 2012;35(1):15–26. This RCT successfully implemented CHWs into a team-based care model to improve diabetes self-management. The intervention group was more likely to set self-management goals.

22.

• Walton JW, Snead CA, Collinsworth AW, Schmidt KL. Reducing diabetes disparities through the implementation of a community health worker-led diabetes self-management education program. Fam Community Health. 2012;35(2):161–71. This study utilized a team-based approach, and provided a detailed description of recruitment and training methods for CHWs. Outcomes at 18 months showed improved HbA1c and high levels of satisfaction with the program.

23.

•• Cherrington A, Ayala GX, Amick H, et al. Implementing the community health worker model within diabetes management: challenges and lessons learned from programs across the United States. Diabetes Educ. 2008;34(5):824–33. This qualitative study examined CHW interventions across the United States and found that roles, characteristics, and training of CHWs varied across programs.PubMedCrossRef

24.

• Ferguson WJ, Lemay CA, Hargraves JL, et al. Developing community health worker diabetes training. Health Educ Res. 2012;27(4):755–65. This study reported findings on the development and implementation of a diabetes self-management CHW certificate course. Outcomes include improved knowledge and skills in diabetes self-management, and recommendations for CHW training programs.

25.

Perez M, Findley SE, Mejia M, Martinez J. The impact of community health worker training and programs in NYC. J Health Care Poor Underserved. 2006;17(1 Suppl):26–43.PubMed

26.

• Colleran K, Harding E, Kipp BJ, et al. Building capacity to reduce disparities in diabetes: training community health workers using an integrated distance learning model. Diabetes Educ. 2012;38(3):386–96. This study developed an onsite and video-conference-based training program for CHWs. Participants gained new knowledge, skills and confidence. The distance-learning strategy allowed for extended training of diverse participants.

27.

• Ayala GX, Vaz L, Earp JA, et al. Outcome effectiveness of the lay health advisor model among Latinos in the United States: an examination by role. Health Educ Res. 2010;25(5):815–40. This systematic review examined CHWs by role, with a focus on educator-only and educator-plus-bridge programs. Educator-only program reached more participants and employed nearly all CHWs as staff. Educator-plus-bridge programs had more one-on-one contact with participants.

28.

• Findley SE, Matos S, Hicks AL, et al. Building a consensus on community health workers' scope of practice: lessons from New York. Am J Public Health. 2012;102(10):1981–7. This study set out to better understand how and for whom CHWs are most effective by building a consensus between CHWs and employers on training, certification and scope of practice. Nearly all CHWs surveyed were willing to complete additional training, and most employers agreed that standardizing training would improve effectiveness. Five roles were identified for CHWs.

Titel: The Role of Community Health Workers in Diabetes: Update on Current Literature
verfasst von: Megha Shah
Elizabeth Kaselitz
Michele Heisler
Publikationsdatum: 01.04.2013
Verlag: Current Science Inc.
Erschienen in: Current Diabetes Reports / Ausgabe 2/2013
Print ISSN: 1534-4827
Elektronische ISSN: 1539-0829
DOI: https://doi.org/10.1007/s11892-012-0359-3

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