Evaluation of a Community Health Worker Pilot Intervention to Improve Diabetes Management in Bangladeshi Immigrants With Type 2 Diabetes in New York City
Restricted accessResearch articleFirst published online July, 2013
Evaluation of a Community Health Worker Pilot Intervention to Improve Diabetes Management in Bangladeshi Immigrants With Type 2 Diabetes in New York City
The purpose of this study is to explore the impact and feasibility of a pilot Community Health Worker (CHW) intervention to improve diabetes management among Bangladeshi-American individuals with type 2 diabetes living in New York City.
Methods
Participants were recruited at clinic- and community-based venues. The intervention consisted of 6 monthly, CHW-facilitated group sessions on topics related to management of diabetes. Surveys were collected at baseline and follow-up time points. Study outcomes included clinical, behavioral, and satisfaction measures for participants, as well as qualitative measures from CHWs.
Results
Improvements were seen in diabetes knowledge, exercise and diet to control diabetes, frequency of checking feet, medication compliance, and self-efficacy of health and physical activity from baseline to 12 months. Additionally, there were decreases in A1C, weight, and body mass index. Program evaluation revealed a high acceptability of the intervention, and qualitative findings indicated that CHWs helped overcome barriers and facilitated program outcomes through communal concordance, trust, and leadership.
Conclusions
The intervention demonstrated high acceptability and suggested efficacy in improving diabetes management outcomes among Bangladeshi immigrants in an urban setting. The US Bangladeshi population will continue to increase, and given the high rates of diabetes, as well as linguistic and economic barriers faced by this community, effective and culturally tailored health interventions are needed to overcome barriers and provide support for diabetes management.
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References
1.
Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: Department of Health and Human Services, Centers for Disease Control and Prevention; 2011.
2.
EngelgauMMGeissLSSaaddineJB. The evolving diabetes burden in the United States. Ann Intern Med. 2004;140:945-950.
3.
BoyleJPThompsonTJGreggEWBarkerLEWilliamsonDF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Population Health Metrics. 2010;8:29.
4.
LeeJWBrancatiFLYehHC. Trends in the prevalence of type 2 diabetes in Asians versus whites: results from the United States National Health Interview Survey, 1997-2008. Diabetes Care. 2011;34:353-357.
5.
ThorpeLEUpadhyayUDChamanyS. Prevalence and control of diabetes and impaired fasting glucose in New York City. Diabetes Care. 2009;32:57-62.
6.
RajpathakSNGuptaLSWaddellEN. Elevated risk of type 2 diabetes and metabolic syndrome among Asians and south Asians: results from the 2004 New York City HANES. Ethnic Dis. 2010;20:225-230.
7.
GuptaLSWuCCYoungSPerlmanSE. Prevalence of diabetes in New York City, 2002-2008: comparing foreign-born South Asians and other Asians with U.S.-born whites, blacks, and Hispanics. Diabetes Care. 2011;34:1791-1793.
8.
BhalodkarNCBlumSRanaTKitchappaRBhalodkarANEnasEA. Comparison of high-density and low-density lipoprotein cholesterol subclasses and sizes in Asian Indian women with Caucasian women from the Framingham Offspring Study. Clin Cardiol. 2005;28:247-251.
9.
BhopalRUnwinNWhiteM. Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi, and European origin populations: cross sectional study. BMJ. 1999;319:215-220.
10.
Oza-FrankRAliMKVaccarinoVNarayanKM. Asian Americans: diabetes prevalence across U.S. and World Health Organization weight classifications. Diabetes Care. 2009;32:1644-1646.
11.
WildSRoglicGGreenASicreeRKingH. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047-1053.
12.
BarnesJSBennettCE. The Asian Population: 2000. Washington, DC: US Department of Commerce; 2002.
13.
IslamNTandonDMukherjiR. Understanding barriers and facilitators to diabetes control andprevention in the New York City Bangladeshi community: a mixed-methods approach to inform the development of a community health worker intervention. Am J Public Health. 2012;102:486-490.
14.
PatelVVRajpathakSKaraszA. Bangladeshi immigrants in New York City: a community based health needs assessment of a hard to reach population. J Immigr Minor Health. 2012;14:767-773.
15.
RianonNJRasuRS. Metabolic syndrome and its risk factors in Bangladeshi immigrant men in the USA. J Immig Minor Health. 2010;12:781-787.
16.
ChoudhurySMBrophySFareediMAZamanBAhmedPWilliamsR. Examining the effectiveness of a peer-led education programme for type 2 diabetes and cardiovascular disease in a Bangladeshi population. Diabetic Med. 2009;26:40-44.
17.
ChoudhurySMBrophySWilliamsR. Understanding and beliefs of diabetes in the UK Bangladeshi population. Diabetic Med. 2009;26:636-640.
18.
HayesLWhiteMUnwinN. Patterns of physical activity and relationship with risk markers for cardiovascular disease and diabetes in Indian, Pakistani, Bangladeshi and European adults in a UK population. J Public Health Med. 2002;24:170-178.
19.
RhodesPNoconA. A problem of communication? Diabetes care among Bangladeshi people in Bradford. Health Soc Care Community. 2003;11:45-54.
20.
RhodesPNoconAWrightJ. Access to diabetes services: the experiences of Bangladeshi people in Bradford, UK. Ethn Health. 2003;8:171-188.
Community Health Needs & Resource Assessment: An Exploratory Study of South Asians in NYC. New York: NYU Center for the Study of Asian American Health; 2007.
23.
Profile of New York City’s Bangladeshi Americans: 2005-2007. New York: Asian American Federation Census Information Center; 2009.
24.
HsuCCChenLHuYWYipWShuCC. The dimensions of responsiveness of a health system: a Taiwanese perspective. BMC Public Health. 2006;6:72.
25.
LoveMBGardnerKLegionV. Community health workers: who they are and what they do. Health Educ Behav. 1997;24:510-522.
26.
KriegerJKTakaroTKAllenC. The Seattle-King County healthy homes project: implementation of a comprehensive approach to improving indoor environmental quality for low-income children with asthma. Environ Health Perspect. 2002;110(suppl 2):311-322.
27.
MartinMAHernandezONaureckasELantosJ. Reducing home triggers for asthma: the Latino community health worker approach. J Asthma. 2006;43:369-374.
28.
ViswanathanMKraschnewskiJLNishikawaB. Outcomes and costs of community health worker interventions: a systematic review. Med Care. 2010;48:792-808.
29.
Diabetes community health workers. Diabetes Educ. 2003;29:818, 821-814.
30.
American Public Health Association Resolution. Recognition and Support for Community Health Workers’ Contribution to Meeting Our Nation’s Health Care Needs. Washington, DC: APHAR; 2002.
31.
Centers for Disease Control and Prevention. Community Health Workers and Promotores de Salud: Critical Connections in Communities. Atlanta, GA: Centers for Disease Control and Prevention Department of Health and Human Services; 2003.
32.
Anderson-LoftinWBarnettSSullivanPBunnPSTavakoliA. Culturally competent dietary education for southern rural African Americans with diabetes. Diabetes Educ. 2002;28:245-257.
33.
AubertREHermanWHWatersJ. Nurse case management to improve glycemic control in diabetic patients in a health maintenance organization. A randomized, controlled trial. Ann Intern Med. 1998;129:605-612.
34.
BabamotoKSSeyKACamilleriAJKarlanVJCatalasanJMoriskyDE. 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.
35.
BrownSAGarciaAAKouzekananiKHanisCL. Culturally competent diabetes self-management education for Mexican Americans: the Starr County border health initiative. Diabetes Care. 2002;25:259-268.
36.
CastilloAGiachelloABatesR. Community-based diabetes education for Latinos: the Diabetes Empowerment Education Program. Diabetes Educ. 2010;36:586-594.
37.
GaryTLBatts-TurnerMBoneLR. A randomized controlled trial of the effects of nurse case manager and community health worker team interventions in urban African-Americans with type 2 diabetes. Controlled Clin Trials. 2004;25:53-66.
38.
Philis-TsimikasAWalkerCRivardL. Improvement in diabetes care of underinsured patients enrolled in project dulce: a community-based, culturally appropriate, nurse case management and peer education diabetes care model. Diabetes Care. 2004;27:110-115.
39.
StatenLKScheuLLBronsonDPenaVElenesJ. Pasos Adelante: the effectiveness of a community-based chronic disease prevention program. Prev Chronic Dis. 2005;2:A18.
40.
ThompsonJRHortonCFloresC. Advancing diabetes self-management in the Mexican American population: a community health worker model in a primary care setting. Diabetes Educ. 2007;33(suppl 6):159S-165S.
41.
VetterMJBristowLAhrensJ. A model for home care clinician and home health aide collaboration: diabetes care by nurse case managers and community health workers. Home Healthc Nurse. 2004;22:645-648.
42.
NguyenTTMcPheeSJBui-TongN. Community-based participatory research increases cervical cancer screening among Vietnamese-Americans. J Health Care Poor Underserved. 2006;17:31-54.
43.
TuSPTaylorVYasuiY. Promoting culturally appropriate colorectal cancer screening through a health educator: a randomized controlled trial. Cancer. 2006;107:959-966.
44.
BeckhamSBradleySWashburnATaumuaT. Diabetes management: utilizing community health workers in a Hawaiian/Samoan population. J Health Care Poor Underserved. 2008;19:416-427.
45.
HanHRKimKBKimMT. Evaluation of the training of Korean community health workers for chronic disease management. Health Educ Res. 2007;22:513-521.
46.
KimMTHanHRSongHJ. A community-based, culturally tailored behavioral intervention for Korean Americans with type 2 diabetes. Diabetes Educ. 2009;35:986-994.
47.
IsraelBASchultzAJParkerEABeckerAB. Community-based research: a partnership approach to improve public health. Annu Rev Public Health. 1998;19:173-202.
48.
MinklerMWallersteinN, eds. Community-Based Participatory Research for Health. San Francisco: Jossey-Bass; 2003.
49.
BalcazarHGByrdTLOrtizMTondapuSRChavezM. A randomized community intervention to improve hypertension control among Mexican Americans: using the promotoras de salud community outreach model. J Health Care Poor Underserved. 2009;20:1079-1094.
50.
KnowlesM. The Modern Practice of Adult Education. New York: Association Press; 1980.
dela CruzFAPadillaGVAgustinEO. Adapting a measure of acculturation for cross-cultural research. J Transcult Nurs. 2000;11:191-198.
54.
FitzgeraldJTFunnellMMHessGE. The reliability and validity of a brief diabetes knowledge test. Diabetes Care. 1998;21:706-710.
55.
HarrisJMcGeeAAndrewsFD’SouzaJSprostonK. The National Survey of People With Diabetes. London: Healthcare Commission; 2007.
56.
Krousel-WoodMMuntnerPJannuADesalvoKReRN. Reliability of a medication adherence measure in an outpatient setting. Am J Med Sci. 2005;330:128-133.
57.
BanduraA. Self-Efficacy Beliefs of Adolescents. New York: Information Age Publishing; 2006:307-337.
58.
KroenkeKSpitzerRLWilliamsJB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606-613.
59.
GriffinJAGillilandSSPerezGHelitzerDCarterJS. Participant satisfaction with a culturally appropriate diabetes education program: the Native American Diabetes Project. Diabetes Educ. 1999;25:351-363.
60.
Felix-AaronKLBoneLRLevineDMRubinHR. Using participant information to develop a tool for the evaluation of community health worker outreach services. Ethnic Dis. 2002;12:87-96.
61.
BrownsteinJNBoneLRDennisonCRHillMNKimMTLevineDM. Community health workers as interventionists in the prevention and control of heart disease and stroke. Am J Prev Med. 2005;29:128-133.
62.
NorrisSLChowdhuryFMVan LeK. Effectiveness of community health workers in the care of persons with diabetes. Diabetic Med. 2006;23:544-556.
63.
SwiderSM. Outcome effectiveness of community health workers: an integrative literature review. Public Health Nurs. 2002;19:11-20.
64.
MishlerEG. Research Interviewing: Context and Narrative. Cambridge: Harvard University Press; 1986.
65.
RiessmanCK. Narrative Analysis. Newbury Park, CA: Sage Publications; 1993.
66.
D’Eramo-MelkusGSpollettGJeffersonV. A culturally competent intervention of education and care for black women with type 2 diabetes. Appl Nurs Res. 2004;17:10-20.
67.
MauldonMMelkusGDCagganelloM. Tomando Control: a culturally appropriate diabetes education program for Spanish-speaking individuals with type 2 diabetes mellitus—evaluation of a pilot project. Diabetes Educ. 2006;32:751-760.
