Health Disparity
Observational Stepped-Wedge Analysis of a CHW-Led Intervention for Diabetes and Hypertension in Rural Mexico
BMJ Open. 2020 Mar 8;10(3):e034749. [Pubmed Abstract]
Worster DT, Franke MF, Bazúa R, Flores H, García Z, Krupp J, Maza J, Palazuelos L, Rodríguez K, Newman PM, Palazuelos D
Objectives
There is emerging interest and data supporting the effectiveness of community health workers (CHWs) in non-communicable diseases (NCDs) in low/middle-income countries (LMICs). This study aimed to determine whether a CHW-led intervention targeting diabetes and hypertension could improve markers of clinical disease control in rural Mexico.
Design and setting
A prospective observational stepped-wedge study was conducted across seven communities in rural Chiapas, Mexico from March 2014 to April 2018.
Participants
149 adults with hypertension and/or diabetes.
Intervention
This study was conducted in the context of the programmatic roll-out of an accompaniment-based CHW-led intervention designed to complement comprehensive primary care for adults with diabetes and/or hypertension….
CHW Support for Disadvantaged Patients With Multiple Chronic Diseases: A Randomized Clinical Trial
Am J Public Health. 2017 Oct;107(10):1660-1667. [Pubmed Abstract]
Kangovi S, Mitra N, Grande D, Huo H, Smith RA, Long JA
Objectives
To determine whether a community health worker (CHW) intervention improved outcomes in a low-income population with multiple chronic conditions.
Methods
We conducted a single-blind, randomized clinical trial in Philadelphia, Pennsylvania (2013-2014). Participants (n = 302) were high-poverty neighborhood residents, uninsured or publicly insured, and diagnosed with 2 or more chronic diseases (diabetes, obesity, tobacco dependence, hypertension). All patients set a disease-management goal. Patients randomly assigned to CHWs also received 6 months of support tailored to their goals and preferences.
Results
Support from CHWs (vs goal-setting alone) led to improvements in several chronic diseases (changes in glycosylated hemoglobin: -0.4 vs 0.0; body mass index: -0.3 vs -0.1; cigarettes per day: -5.5 vs -1.3; systolic blood pressure: -1.8 vs…
RCT of a CHW Self-Management Support Intervention Among Low-Income Adults With Diabetes, Seattle, Washington, 2010-2014
Prev Chronic Dis. 2017 Feb 9;14:E15. [Pubmed Abstract]
Nelson K, Taylor L, Silverman J, Kiefer M, Hebert P, Lessler D, Krieger J
Introductions
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…
