Randomized controlled trial of a community health worker self-management support intervention among low-income adults with diabetes, Seattle, Washington, 2010-2014

Abstract

Introduction Community health workers (CHWs) can improve diabetes outcomes; however, questions remain about translating research findings into practical low-intensity models forsafety-net providers. We tested the effectiveness of ahome-basedlow-intensity CHW intervention for improving health outcomes among low-income adults with diabetes. Methods Low-incomepatients with glycated hemoglobin A1c (HbA1c) of 8.0% or higher in the 12 months before enrollment from 3safetynetproviders were randomized to a12-monthCHW-delivered diabetes self-management intervention or usual care. CHWs were based at a local health department. The primary outcome was change in HbA1c from baseline enrollment to 12 months; secondary outcomes included blood pressure and lipid levels, quality of life, and health care use. Results The change in HbA1c in the intervention group (n = 145) (unadjusted mean of 9.09% to 8.58%, change of -0.51) compared with the control group (n = 142) (9.04% to 8.71%, change of -0.33) was not significant (P= .54). In an analysis of participants with poor glycemic control (HbA1c > 10%), the intervention group had a 1.23-pointgreater decrease in HbA1c compared with controls (P= .046). For the entire study population, we found a decrease in reported physician visits (P 10% at baseline), the intervention was effective.