Alliance to Reduce Disparities in Diabetes

Wind River Team at Spectrum Health CHW Conference 2014

Improving Diabetes Outcomes through Tribal Community Health Workers

Spectrum Health Healthier Communities 7th Annual Community Health Worker Conference
August 21, 2014
Grand Rapids, MI

Authors
Kathryn Langwell, Mary Rogers, and Matthew Zullo

Abstract
Need: The age-adjusted prevalence of diabetes among American Indians and Alaska Natives served by the Indian Health Service is substantially higher than for other racial/ethnic groups in the U.S., at 16.1 percent of the adult population.  Most American Indian Reservations are served by Indian Health Service which has limited resources due to under-funding and difficulties in recruiting and hiring staff in locations that are remote and highly rural. Consequently, Tribal members with diabetes or pre-diabetes seldom have Diabetes Self-Management Education classes and other ongoing support services available. As a result, mortality rates due to diabetes are four times the national average.

Goals and Timeframe: The goal of this program was to improve diabetes management and prevention through training of Tribal community health workers to provide diabetes self-management education and follow-up physical activity and nutrition education. The program was initiated in 2009, with a one-year planning grant, with implementation of the program operating for over four years.

Community Health Workers’ Roles in the Program: Tribal community health workers were central to the delivery of the program, including recruitment of Tribal members with diabetes or pre-diabetes through home visits and health fairs, participating in training from clinical, exercise, and nutrition experts to prepare them to provide DSME classes to Tribal members, delivery of the DSME program to over 300 people, providing follow-up motivational messages through text and telephone, receiving training of Group Lifestyle Balance, and working with fitness center staff to develop tailored physical activity programs for participants. Evaluation of the impact of the initial four years of the program indicate that DSME provided by lay health educators, resulted in positive changes in confidence in ability to manage diabetes, health behaviors, and clinical outcomes for participants.