Research article
Participants' Assessments of the Effects of a Community Health Worker Intervention on Their Diabetes Self-Management and Interactions with Healthcare Providers

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Background

The specific ways in which community health worker (CHW) programs affect participants' healthcare behaviors and interactions with their healthcare providers, as well as mechanisms by which CHW programs influence these outcomes, are poorly understood. A qualitative descriptive study of participants in a successful CHW diabetes self-management program was designed to examine: (1) what gaps in diabetes care, with a focus on patient–doctor interactions, participants identify; (2) how the program influences participants' diabetes care and interactions with healthcare providers, and what gaps, if any, it addresses.

Methods

From November 2005 to December 2006, semi-structured interviews with 40 African- American and Latino adults were conducted and analyzed. Participants had diabetes and had completed or were active in a CHW-led diabetes self-management program developed and implemented using community-based participatory research principles in Detroit. Interviews were audiotaped, transcribed, and coded through a consensual and iterative process.

Results

Participants reported that prior to the intervention they had received inadequate information from healthcare providers for effective diabetes self-management, had had low expectations for help from their providers, and had not felt comfortable asking questions or making requests of their healthcare providers. Key ways participants reported that the program improved their ability to manage their diabetes were by providing (1) clear and detailed information on diabetes and diabetes care; (2) education and training on specific strategies to meet diabetes care goals; (3) sustained and nonjudgmental assistance to increase their motivation and confidence; and (4) social and peer support that enabled them to better manage their diabetes. The knowledge and confidence gained through the CHW intervention increased participants' assertiveness in asking questions to and requesting necessary tests and results from their providers.

Conclusions

Study findings suggest ways that CHW programs that provide both one-on-one support and group self-management training sessions may be effective in promoting more effective diabetes care and patient–doctor relationships among Latino and African-American adults with diabetes. Through these mechanisms, such interventions may help to mitigate racial and ethnic disparities in diabetes care and outcomes.

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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