AJN, American Journal of Nursing:
In the News
Results in American Samoa could translate to other medically underserved areas.
Community health workers (CHWs) in American Samoa, led by a nurse manager, successfully helped adults with type 2 diabetes to lower their blood glucose levels. In the island territory southwest of Hawaii, 21.5% of adults have type 2 diabetes, nearly double the national rate.
The 268 participants received either free CHW care or standard care. The CHWs were local residents who made home visits weekly, monthly, or quarterly, depending on the diabetes health risk. They tested blood glucose, provided education on diet and exercise, reminded patients to take medicines, and helped them solve care problems.
After one year, 42% of subjects in the intervention group had reduced their glycated hemoglobin (HbA1c) level by 0.5% (considered clinically significant), compared with 32% of those receiving standard care. Patients receiving CHW care were twice as likely to reduce their HbA1c level by 0.5%, and high-risk patients, who saw CHWs most often, made the greatest improvements.
Costs are a barrier to diabetes care in American Samoa. “Patients in this area have difficulty paying the $10 copays for medical visits. The free home visits were very positively received,” says study leader Judith DePue, clinical professor of psychiatry and human behavior at Brown University in Providence, Rhode Island.
CHWs used culturally based flip charts, adapted from the National Diabetes Education Program, which included information about diet, exercise, risk reduction, medications, and managing stress. “Flip charts made it easy for CHWs to teach in the field—they had talking points,” says DePue.
High-risk patients were asked to attend weekly group classes but often missed them, so the CHWs tracked them down at home or work. That flexibility boosted attendance to 74% of expected visits. “I would not want to rely on group visits alone,” says DePue.
Like many rural settings, American Samoa is medically underserved and has a shortage of health care professionals. The nurse leader had training equivalent to that of an RN. The CHWs, who had high school educations, were trained for their diabetes care tasks. “The CHW team extends the reach of health care in settings with a shortage of health professionals,” says DePue, who believes that these results support using CHW teams to serve other resource-poor and high-risk populations.—Carol Potera
DePue JD, et al. Diabetes Care 2013 Feb 14. [Epub ahead of print.]