Long- Term Impact of a Community Health Worker Intervention on Diabetes Control in American Samoa. Mayuree Rao, BA; Judith D. De. Pue, Ed. D, MPH; Shira Dunsiger, Ph. D; Mohammad Elsayed, BA; Ofeira Nu'usolia, MEd; Stephen T. Mc. Garvey, Ph. D, MPHSuggested citation for this article: Rao M, De. Pue JD, Dunsiger S, Elsayed M, Nu'usolia O, Mc. Garvey ST. Long- Term Impact of a Community Health Worker Intervention on Diabetes Control in American Samoa. Prev Chronic Dis 2. Deals in Pune (357 Discount Offers. Up to 62% Discount on Weight Loss Treatment at Dr.Parekhs Homoeopathy and Nutrition Clinic in Wanow. VLCC Institute, with more than 70 institutes in India and Nepal, is a leader in Beauty & Wellness training. Established in 2001 by the VLCC group, VLCC Institute. Suhas is a compassionate healer and expert clinician who directs the Ayurvedic Healing and Integrative Wellness Clinic in. Pituitary Network Association Continuing Education Program; Pituitary Network Association. Scott Hamilton; Join Now; One In Five; PNA Guide; Apple; National. DOI: http: //dx. doi. PEER REVIEWEDAbstract. Introduction. Diabetes Care in American Samoa (DCAS) was a randomized controlled trial of a 1. CHWs) that demonstrated improved Hb. A1c levels compared with usual care at trial completion. We sought to evaluate the long- term impact of this intervention on diabetes control. Methods. We retrospectively collected Hb. A1c measurements from medical records of DCAS participants (n = 2. The study group received the intervention during the trial, and the control group received the intervention after the trial. We used mixed- effects longitudinal regression models to assess change in Hb. A1c within each trial arm during 3 time periods: DCAS (1. DCAS (control group’s intervention), and the second year after DCAS. Models were adjusted for baseline characteristics that differed significantly for participants with a low number of Hb. A1c measurements from those with a high number of Hb. A1c measurements. Results. After adjustment for confounders, the experiment group experienced a decrease in Hb. A1c of 0. 2. 8 units per year (9. Hb. A1c decreased by 0. CI, . No significant change was observed the following year. Hb. A1c of the control group did not significantly change during DCAS (usual care) but decreased by 1. CI, . During the year after the control group’s intervention, Hb. A1c increased by 1. CI, 0. 4. 2 to 1. Conclusion. Both groups had initial improvements in glycemic control, but Hb. A1c later plateaued or increased. These results suggest that time- limited CHW programs improve diabetes control in the short term, but ongoing programs are needed for sustained impact. This site uses Cookies. By continuing to browse you agree to the use of cookies.Top. Introduction. Levels of type 2 diabetes in the US Territory of American Samoa are among the highest in the world, with an estimated prevalence of 2. The high prevalence of diabetes is associated with lifestyle changes accompanying economic modernization, including reduced physical activity and a shift to imported and highly processed foods (2,3). Furthermore, as a medically underserved area with a shortage of health professionals (4), American Samoa has limited health resources available for diabetes management. Diabetes Care in American Samoa (DCAS) was a randomized controlled trial of a 1. American Samoa and delivered by a team comprising a trained nurse and community health workers (CHWs). The experiment group was compared with a control group who received usual care and who also received the intervention after the study ended. At trial completion, Hb. A1c, a measure of average blood glucose, was 0. Most programs that use CHWs in diabetes care are time- limited (median duration: 6 months), and few follow up with participants long- term (6,7). The results of this study contribute to evidence supporting the effectiveness of CHWs in diabetes care (7. However, little is known about whether short- term improvements in diabetes control are sustained after CHW interventions are over (8). Here, we report the longer- term impact of our 1. CHW intervention on diabetes control. Our objective was to evaluate the change in Hb. A1c by trial arm for 3 consecutive 1- year periods (Figure 1). We hypothesized that Hb. A1c would increase over time in the experiment group after the intervention ended. For the control group, we expected Hb. A1c to decrease during the intervention and increase after its completion. Figure 1. Timeline of study analysis. Change in Hb. A1c over time was evaluated by trial arm during 3 consecutive 1- year periods: 1) DCAS period; 2) first year after DCAS completion; and 3) second year after DCAS completion. Abbreviation: DCAS, Diabetes Care in American Samoa. Details are discussed elsewhere (5). Briefly, the study design and intervention was adapted from Project Sugar 2, a nurse- CHW team intervention for diabetes management for African Americans in Baltimore, Maryland (9,1. DCAS participants were drawn from the patient population of Tafuna Clinic, a federally qualified community health center. Villages within the clinic. To limit contamination, villages were randomized to the experiment or control group on the basis of size and location so that intervention and usual- care villages were not adjacent. As part of the study design, the control group also received the CHW intervention following the completion of the trial. DCAS participants were enrolled by Tafuna Clinic staff on a rolling basis from February 2. May 2. 01. 0. Eligibility criteria were broad to test real- world effectiveness: aged 1. Samoan, type 2 diabetes diagnosed by a physician, mentally competent and able to give informed consent, unlikely to leave American Samoa for more than 4 months during the study, and having no serious comorbid conditions (eg, end- stage renal disease, cancer). Because recruitment initially yielded fewer patients with diagnosed diabetes than expected, Tafuna Clinic providers extended the criteria to include newly diagnosed patients after community diabetes screenings and confirmation of diabetes diagnosis. Our study sample comprised all 2. DCAS: 1. 04 assigned to the experiment group and 1. Figure 2). The primary outcome measure was Hb. A1c, collected retrospectively from the medical records of DCAS participants. After the parent study (DCAS trial) ended, medical records were used because additional study measurements could not be collected in person. Figure 2. Consolidated Standards of Reporting Trial (CONSORT) diagram of recruitment. In this intent- to- treat analysis, participants who did not complete 1. Abbreviations: CHW, community health worker; DCAS, Diabetes Care in American Samoa. Therefore, each group was compared with itself over time. All study protocols and informed consent procedures were approved by the institutional review boards of the American Samoa Department of Health and Brown University. DCAS intervention. The DCAS staff consisted of a nurse care manager and 4 CHWs. CHWs were recruited from the community through the Tafuna Clinic employee hiring system; the position required a high school education with some health care experience preferred. All CHWs were trained by study investigators, including a primary care physician, registered nurse and diabetes educator, and behavioral interventionist. Training included research practice, standards of care including American Diabetes Association guidelines (1. CHWs were further certified in diabetes knowledge and in procedures for taking blood glucose, blood pressure, and height and weight measurements. Study participants were classified into 1 of 3 risk profiles, which determined intervention frequency and intensity. Risk profiles were based on an algorithm that used Hb. A1c, blood pressure, smoking status, alcohol use, and Patient Health Questionnaire (PHQ- 9) depression scores measured at study enrollment. BMI was not included in the risk profile, given that 9. American Samoans are overweight or obese (1. Low- risk participants received a one- on- one home CHW visit every 3 months, moderate- risk participants received a one- on- one CHW home visit monthly, and high- risk participants had weekly group meetings with the nurse care manager and CHW, or one- on- one meetings with a CHW if they were unavailable for group meetings. Intervention content included 8 possible topics chosen from the American Association of Diabetes Educators. Topic selection was guided by the risk profile and self- selected goals of the participants. CHWs used flipcharts including sections on each of the 8 topics to facilitate diabetes education during visits with participants. Flipcharts were modeled on the National Diabetes Education Program flipcharts for diabetes prevention and adapted for the local cultural context (1. Given the intervention time frame and limited scope of the CHWs. After this baseline assessment, the experiment group received the 1. CHW intervention while the control group received usual care, including any regularly scheduled primary care appointments. The biological, behavioral, and psychosocial measures of both groups were assessed 1. After the follow- up assessment, the control group began receiving the CHW intervention. The data collected at baseline and 1. Because of rolling enrollment, the period of data collection after the experiment arm and the control arm completed the intervention ranged from 1. Hb. A1c measurements were abstracted from 2 sources: 1) paper medical records at Tafuna Clinic and 2) the Computerized Patient Record System at Lyndon B. Johnson (LBJ) Tropical Medical Center, the only hospital in American Samoa, which provides emergency, acute, and specialty care. Although participants may have also obtained care at one of the other community health centers on the island or outside American Samoa, it is unlikely, given the great distances involved in getting such care. Statistical analysis. To determine whether there were any confounding factors related to frequency of Hb. A1c measurement, we compared baseline demographic, biological, behavioral, and psychosocial variables of participants who had a low number of Hb. A1c measurements with those of participants who had a high number of measurements within each trial arm, including the baseline and 1. Hb. A1c levels measured as part of the DCAS trial. Differences were assessed between participants with less than 3 versus 3 or more Hb. A1c measurements during DCAS; almost all participants had at least 2 measurements taken as part of the trial. During subsequent periods, differences were assessed between participants with less than 2 versus 2 or more Hb. A1c measurements.
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