The purpose of this study is to determine whether an innovative interactive distance training program is an effective modality to train community health workers (CHWs) to become members of the diabetes health care team. The University of New Mexico Health Sciences Center has developed a rigorous diabetes training program for CHWs involving both distance and hands-on learning as part of Project ECHO™ (Extension for Community Healthcare Outcomes).
Methods
Twenty-three diverse CHW participants from across New Mexico were enrolled in the first training session. Participants completed surveys at baseline and at the end of the program. They attended a 3-day hands-on training session, followed by weekly participation in tele/video conferences for 6 months. Wilcoxon signed-rank statistics were used to compare pre- and posttest results.
Results
Participants demonstrated significant improvements in diabetes knowledge (P = .002), diabetes attitudes (P = .04) and confidence in both clinical and nonclinical skills (P < .001 and P = .04, respectively). Additionally, during focus group discussions, participants reported numerous benefits from participation in the program.
Conclusions
Community health worker participation in the Project ECHO diabetes training program resulted in significant increases in knowledge, confidence, and attitudes in providing care to patients with diabetes. Studies are ongoing to determine whether the training has a positive impact on patient outcomes.
Get full access to this article
View all access options for this article.
References
1.
HuangESBasuAO’GradyM. Projecting the future diabetes population size and related costs for the US. Diabetes Care. 2009;32:2225-2229.
2.
NarayanKMBoyleJPThompsonTJ. Lifetime risk for diabetes mellitus in the United States. JAMA. 2003;290:1884-1890.
3.
KnowlerWCBarrett-ConnorEFowlerSE. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403.
4.
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352:837-853.
5.
ColhounHMBetteridgeDJDurringtonPN. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004;364:685-696.
6.
ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288:2981-2997.
7.
GersteinHC.Reduction of cardiovascular events and microvascular complications in diabetes with ACE inhibitor treatment: HOPE and MICRO-HOPE. Diabetes Metab Res Rev. 2002;18(Suppl 3):S82-S85.
8.
WagnerEHSandhuNNewtonKM. Effect of improved glycemic control on health care costs and utilization. JAMA. 2001;285:182-189.
9.
CowieCCRustKFFordES. Full accounting of diabetes and pre-diabetes in the US population in 1988-1994 and 2005-2006. Diabetes Care. 2009;32:287-294.
10.
Centers for Disease Control and Prevention. National Diabetes Fact Sheet: national estimates and general information on diabetes and prediabetes in the United States. http://diabetes.niddk.nih.gov/dm/pubs/statistics, 2011. Accessed August 26, 2011.
11.
SaydahSFradkinJCowieC.Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA. 2004;291:335-342.
12.
ColleranKMRichardsAShaferK.Disparities in cardiovascular disease risk and treatment: demographic comparison. J Investig Med. 2007;55:415-422.
13.
LarmeACPughJA.Attitudes of primary care providers toward diabetes: barriers to guideline implementation. Diabetes Care. 1998;21:1391-1396.
14.
LitzelmanDKTierneyWM.Physicians’ reasons for failing to comply with computerized preventive care guidelines. J Gen Intern Med. 1996;11:497-499.
15.
DavidsonMB.The case for “outsourcing” diabetes care. Diabetes Care. 2003;26:1608-1612.
16.
ColleranKMStarrBBurgeMR.Putting diabetes to the test: analyzing glycemic control based on patients’ diabetes knowledge. Diabetes Care. 2003;26:2220-2221.
17.
American Diabetes Association. Economic costs of diabetes in the US in 2007. Diabetes Care. 2008;31:596-615.
18.
AroraSKalishmanSThorntonK. Expanding access to hepatitis C virus treatment–Extension for Community Healthcare Outcomes (ECHO) project: disruptive innovation in specialty care. Hepatology. 2010;52:1124-1133.
19.
AroraSGeppertCMKalishmanS. Academic health center management of chronic diseases through knowledge networks: Project ECHO. Acad Med. 2007;82:154-160.
20.
AroraSThorntonKJenkuskySM. Project ECHO: linking university specialists with rural and prison-based clinicians to improve care for people with chronic hepatitis C in New Mexico. Public Health Rep. 2007;122(Suppl 2): 74-77.
21.
KirkmanMSWilliamsSRCaffreySH. Impact of a program to improve adherence to diabetes guidelines by primary care physicians. Diabetes Care. 2002;25:1946-1951.
22.
RuoffGGrayLS.Using a flow sheet to improve performance in treatment of elderly patients with type 2 diabetes. Fam Med. 1999;31:331-336.
23.
BailieRSSiDRobinsonGW. A multifaceted health-service intervention in remote Aboriginal communities: 3-year follow-up of the impact on diabetes care. Med J Aust. 2004;181:195-200.
24.
DeichmannRECastelloEHorswellR. Improvements in diabetic care as measured by HbA1c after a physician education project. Diabetes Care. 1999;22:1612-1616.
25.
BenjaminEMSchneiderMSHincheyKT.Implementing practice guidelines for diabetes care using problem-based learning. A prospective controlled trial using firm systems. Diabetes Care. 1999;22:1672-1678.
26.
DavidsonMB.Effect of nurse-directed diabetes care in a minority population. Diabetes Care. 2003;26:2281-2287.
27.
SwiderSMMartinMLynasC. Project MATCH: training for a promotora intervention. Diabetes Educ. 2010;36:98-108.
28.
BeckhamSBradleySWashburnA. Diabetes management: utilizing community health workers in a Hawaiian/Samoan population. J Health Care Poor Underserved. 2008;19:416-427.
29.
BabamotoKSSeyKACamilleriAJ. Improving diabetes care and health measures among hispanics using community health workers: results from a randomized controlled trial. Health Educ Behav. 2009;36:113-126.
30.
CulicaDWaltonJWHarkerK. Effectiveness of a community health worker as sole diabetes educator: comparison of CoDE with similar culturally appropriate interventions. J Health Care Poor Underserved. 2008;19:1076-1095.
31.
BeckerDMYanekLRJohnsonWRJr.. Impact of a community-based multiple risk factor intervention on cardiovascular risk in black families with a history of premature coronary disease. Circulation. 2005;111:1298-1304.
32.
FunnellMMBrownTLChildsBP. National standards for diabetes self-management education. Diabetes Care. 2011;34(S1):S89-96.
33.
AndersonRMDonnellyMBGressardCP. Development of diabetes attitude scale for health-care professionals. Diabetes Care. 1989;12:120-127.
MillerWR.Motivational interviewing with problem drinkers. Behav Psychother. 1983;11:147-172.
36.
HalcombEJGholizadehLDiGiacomoM. Literature review: considerations in undertaking focus group research with culturally and linguistically diverse groups. J Clin Nurs. 2007;16:1000-1011.
