The article Effectiveness of a Community Health Worker Intervention Among African American and Latino Adults With Type 2 Diabetes: A Randomized Controlled Trial reports the results of the study conducted by Spencer et al. (2011) at Detroit, Michigan. The intervention investigated is the use of family health advocates in promoting lifestyle changes in self-management activities among patients. The main hypothesis of the study was “the intervention would significantly improve HbA1c levels in the intervention group compared with the control group” (p.2257). The design of the study was a randomized control trial which utilized a “culturally-tailored CHW intervention” (p. 2254). The results showed that after 6 months, the HbA1c levels of those in the intervention group decreased compared to the control. This means that the use of CHWs was effective in the treatment of diabetes among a specific population.
Research participants come from the African-American and Latino population residing at southwest and eastside Detroit. The southwest part of the city is mostly resided by Latino of Mexican heritage while in the eastside; African-Americans are the majority. The yearly median income of Latino households is $11,500 while African-American households have annual median income of $25020 (Spencer et al., 2011). The researchers initially identified 1719 persons as potential participants. These were adults (18 years and older) diagnosed by doctors as having type 2 diabetes who have identified themselves as either Latino or African-American, and residing in the identified zip codes. The final number of participants was brought down to 183 after excluding persons who refused to participate, cannot be contacted, or had diabetes complications. The final cohort was divided into the intervention group and the control group using randomization. At the start of the study, there were 84 participants in the intervention group and 99 in control group. On the 6th month follow up, only 59 were active in the intervention while there were 77 active participants in the control group.
The tested diabetes-management intervention is the use of community health workers (CHWs) to “promote healthy lifestyle and diabetes self-management activities” (p. 2255). The CHWs were called “family health advocates.” They come from the Latino and African-American communities in Detroit and had 80 hours of training before they applied the intervention. There were three activities that the family health advocates carried out. These were (a) diabetes education classes, (b) two 60-minute home visits per month, and (c) clinic visit with patient and the patient’s primary health care provider. The activities are all culturally-tailored and were given in the English and Spanish languages. Every two weeks, 8-10 participants would attend the two-hour group sessions in the community. The family health advocates assisted the patients in setting up their goals and also referred them to other necessary health systems.
The “randomized controlled trial of 164 African American and Latino adults with type 2 diabetes, the average decrease in HbA1c levels from baseline to 6-month follow-up was 0.8% greater for the CHW intervention group than for the delayed-intervention control group” (2257). This means that the intervention to manage diabetes was effective in the case of the Latino and Africa-American populations.
Significance to Nursing
Health education is one of the key responsibilities of nurses. This study shows that nurses through culturally-appropriate education activities, would be able to effectively contribute to the effective management of diabetes among ethnic populations in the US.
Spencer, M., Rosland, A., Kieffer, E.C., Sinco, B.R., Valerio, M., Palmisano, G., Anderson, M., Guzman, J.R. & and Heisler, M. (2011). Effectiveness of a Community Health Worker Intervention among African American and Latino Adults with Type 2 Diabetes: A Randomized Controlled Trial. American Journal of Public Health, 101(12), 2253-2260. doi:10.2105/AJPH.2010.300106.