地域医療と健康教育

抽象的な

What did the Community Health Worker do that was Helpful? Perceptions from Patients with Type 2 Diabetes

yan CH, Rodriquez A, Gerber BS and Sharp LK

Objective: Evidence supporting the effectiveness of community health worker (CHW) programs in improving type 2 diabetes mellitus (T2DM) outcomes is mixed. This may relate to the different roles or support services CHWs provide across programs. Furthermore, little is known about what activities patients considered most helpful. This summative evaluation reports on patients’ perspectives of CHW activities offered as part of a larger randomized controlled trial of a team-based diabetes-management program.

Methods: Following one-year of access to CHW support, 192 racial/ethnic minorities with uncontrolled T2DM completed a summative evaluation assessing how helpful they found the CHWs, on a ten-point scale, along with an open-ended question about specific activities they found most helpful.

Results: Patients’ mean age was 57 years, 25% identified as Hispanic, of which 47% preferred Spanish, and 75% were African-American. Perceived helpfulness was similar for both groups (Hispanic 9.2, standard deviation [SD] 1.5 vs. African-American 9.1, SD 1.9); although the number of CHW visits was higher among Hispanics compared to African-Americans (9.8, SD 5.4 vs. 5.0, SD 4.7; p<0.001). Conversely, the frequency of CHW visits was similar between Spanish- and English-speaking Hispanics; however, the mean helpfulness rating was higher for Spanish-speakers than for English-speakers (9.6, SD 0.8 vs. 8.8, SD 1.8; p=0.05). After qualitative coding of the list of helpful activities, four major themes emerged: social support, health education, communication with the healthcare team and care coordination.

Conclusion: This study found that CHWs integrated into a healthcare team assisted patients with T2DM, not only in diabetes specific support/education, but also helped them communicate with other team members and coordinate care. An interesting pattern of helpfulness ratings emerged suggesting that frequency of visits with CHWs may be related to factors other than perceived helpfulness. Finally, this is among the first reports of differential CHW engagement within racial/ethnic groups.