Alliance to Reduce Disparities in Diabetes

Health Literacy Conference - Dallas Site

Addressing Health Literacy Beyond the Clinical Encounter: The Use of Community Health Workers in Diabetes Education
Erin Kane, MD (PI), Claudia Chavira, BS, Ashley Collinsworth, MPH, CHW, Kathryn Schmidt, and Christine Snead, RN, BSN 

This project is designed to provide diabetes management and care for uninsured and underinsured residents of Dallas County, who are at a higher risk for developing diabetes and experience disparities in access to health care and health outcomes.  The primary objective of the DEP is to provide patients a culturally and linguistically relevant diabetes management education, delivered by specially trained community health workers (CHWs) called Diabetes Health Promoter (DHP). The patient education intervention component of the Diabetes Equity Project (DEP) offers opportunities for patients to acquire the knowledge, self-care practices, and behaviors required for the effective management of their diabetes. 

CHWs serve as culturally-tailored and linguistically-appropriate liaisons to the patient-provider relationship and increasing access to health services and education. The DEP features DHPs who deliver a structured diabetes education curriculum targeting barriers to diabetes management that Hispanics commonly experience.

DEP participants are scheduled to meet with a  DHP at 1 of the 5 Disease Management Program Sites.  Each patient participates in 3 one-hour, one-on-one educational sessions led by a CHW and quarterly assessments scheduled for 30 to 60 minutes, for a maximum of 6 patient contact hours over 12 consecutive months.. After completion of the initial 12 months of the program, patients can continue to participate indefinitely through quarterly assessment visits. 

Outcomes 
The mean HbA1c value for patients at baseline was 8.7%. A preliminary analysis of the year 1 results revealed a statistically significant change in mean HbA1c levels 1 year post-baseline, dropping from 8.7% to 7.4%.

Additionally, patients were administered the Perceived Competence Scale in Diabetes (PCSD), and DEP patients had significantly higher scores on the PCSD one year post-baseline, with mean scores increasing from 22.53 to 24.18.

Implications
 
The observed improvements in perceived competence in managing diabetes and clinical outcomes experienced by DEP patients indicate that the integration of DHPs into clinical teams to provide education and support to patients may be an effective strategy to improve chronic disease management, particularly in underserved populations.

The success of the DEP and utilizing CHWs as Diabetes Health Promoters to coordinate care and provide diabetes education in underserved populations provides a strong case for the use of this model as a means to augment the traditional treatment of diabetes and other chronic diseases.