American Journal of Preventive Medicine
Research articleParticipants' Assessments of the Effects of a Community Health Worker Intervention on Their Diabetes Self-Management and Interactions with Healthcare Providers
Section snippets
Background
African-American and Latino adults with diabetes experience a higher burden of illness and mortality from diabetes,1, 2, 3, 4, 5 have worse glycemic and blood pressure control, and report experiencing more barriers to diabetes self-management than non-Latino white adults.6, 7, 8 To address such disparities, Detroit was one of 40 cities funded by the CDC as part of the Racial and Ethnic Approaches to Community Health 2010 (REACH) Initiative. In the REACH Detroit Partnership, community, health
Sampling and Data Collection
From November 2005 to December 2006, semi-structured interviews were conducted with 20 African-American and 20 Latino adults who had diabetes and had completed or were currently active in the FHA intervention. With input from FHAs and community members, interview guides were developed in both English and Spanish to elicit descriptions of participants' self-management activities and needs; their interactions with their FHAs and with their healthcare providers before, during, and after their
Sample Description
Telephone calls were placed sequentially using a list of 151 eligible participants, placing up to five calls to 91 participants. Of the 75 who could be reached, 52 agreed to participate; 12 of the completed interviews were unusable as a result of audiorecording errors. Refusers most often cited time constraints as the reason for refusal. Interviews of 40 participants were completed and audiorecorded. Eighteen of these participants had completed the program, and 22 were participating in the
Discussion
These interviews with African-American and Latino adults who had participated in a CHW-led diabetes self-management program supported a number of prior findings from quantitative studies on deficiencies in patient–doctor interactions.1, 20, 21, 22, 23, 24, 25 Striking themes were a lack of adequate information from healthcare providers for effective diabetes self-management, participants' low expectations for help from their providers, and participants' hesitation to make specific requests of
Conclusion
Participants in the FHA intervention delineated deficiencies in both their own prior diabetes knowledge and their interactions with physicians. The deficiencies participants cited in their prior knowledge, motivation, and diabetes self-management support have been identified in multiple studies as key to clinical outcomes. Moreover, such low expectations of and unassertiveness in requesting information and test results from providers contribute to racial and ethnic disparities in chronic
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