CHW Care for Latinos with Diabetes: The DIALBEST Study
Clayton Velicer, MPH
In our August Newsletter we highlighted the growth of community health workers (CHWs), particularly in Latino communities. We also highlighted an example of CHWs using mobile technology to boost impact in underserved Latino communities. In this blog, we’ll look at a related study that was recently covered by Medscape Medical News.
This article in Diabetes Care published results from the Diabetes Among Latinos Best Practices Trial (DIALBEST). In this study, 211 adult Latinos with diabetes were randomized to receive either 17 in-home educational sessions delivered by trained and supervised bilingual/bicultural CHWs or standard care. To help others replicate and scale up the model, the study thoroughly described the CHW training program and delivery of the intervention. In this blog, we took highlights from the article on Medscape Medical News, including commentaries from the research team.
Training and Supporting CHWs
Strong CHW training programs are essential to ensure program quality and improve its effectiveness. This trial recruited two CHWs from different backgrounds that were employed by a community-based nonprofit. One was a nurse from Puerto Rico and second was a medical assistant originally from El Salvador.
The CHWs received 65 hours of interdisciplinary training in which they received training specific to motivational interviewing and communication skills as part of a structured curriculum that covered self-management, lifestyle, adherence and mental health. The CHWs maintained ties to clinical care through weekly meetings with patients’ primary care medical team and a dietician. In a statement published on Medscape Medical News, Dr. Perez-Escamilla underscored the importance of these meetings:
“Those interactions were crucial for the success of DIALBEST, as on the one hand the CHWs learned what to recommend and the clinical basis of these recommendations….On the other hand, providers learned quite a bit about the life circumstances — ie, the social determinants of health — and mental-health challenges being faced by their patients that were preventing them from complying with medical appointments and their ability to self-manage their type 2 diabetes effectively,”
Improved Self-Management, but More Emotional Support Needed
This intervention significantly improved diabetes outcomes and helped patients maintain those improvements over time. The intervention group showed lower HbA1c scores (-0.42 at 3 months, -0.47 at 6 months, -0.57 at 12 months, and -0.55 at 18 months), which were statistically significant at 12 and 18 months.
However, despite including a nutrition education component that tried to account for food access issues and provided step counters, there was no decrease in several physical measures, including body weight.
Dr. Perez-Escamilla states in Medscape Medical News that the lack of weight loss may have been impacted by participants having little social support, mobility issues, and many showing signs of clinical depression.
Take Home Lessons
Shared lived experience and cultural understanding played a key role in the effectiveness of the CHWs. Specifically, the research team cited that an understanding of low economic resources, low health literacy, and low English fluency as areas in which the CHWs were able to address in helping patients improve self-management.
The participants reported a very high level of satisfaction of working with the CHWs. Dr. Perez-Escamilla took the impact of this study as an opportunity to underscore the recent opportunities for CHWs in the US Healthcare system, citing the Affordable Care Act and new funding for the development and implementation of CHW programs. For more, see this Brief on Opportunities for CHWs in the Affordable Care Act.
Looking ahead, the researchers of the DIALBEST study want to further investigate the effectiveness of CHWs in an integrated approach to improve mental health and diabetes self-management at the same time. Dr. Perez-Escamilla is co-leading a randomized controlled trial to investigate whether stress-management sessions delivered by a community health educator might improve blood glucose control among Latinos with type 2 diabetes.
At Peers for Progress we encourage our readers to check out the full article from Medscape Medical News and the findings published in Diabetes Care. We will continue to highlight the great work being done by CHWs and peer supporters and the many ways they can improve chronic-disease self management.