Effect of a Bicultural Community Health Worker on Completion of Diabetes Education in a Hispanic Population

  1. Sheila H Roman, MD, MPH
  1. Departments of Nursing, Mount Sinai Medical Center New York, New York
  2. Departments of Community Medicine, Mount Sinai Medical Center New York, New York
  3. Departments of Medicine, Mount Sinai Medical Center New York, New York
  1. Address correspondence and reprint requests to Sheila H. Roman, MD, MPH, Box 1055, Division of Endocrinology and Metabolism, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029. E-mail: sroman{at}smtplink.mssm.edu

Abstract

OBJECTIVE To determine the effect of a bicultural community health worker (CHW) on completion of diabetes education in an inner-city Hispanic patient population and to evaluate the impact of completion of the education program on patient knowledge, self-care behaviors, and glycemic control.

RESEARCH DESIGN AND METHODS Patients were randomized into CHW intervention and non-CHW intervention groups. All patients received individualized, comprehensive diabetes education from a certified diabetes nurse educator after baseline demographic information, diabetes knowledge, diabetes self-care practices, and glycohemoglobin levels were assessed. Rates of education program completion were determined. Diabetes knowledge, self-care practices, and glycohemoglobin levels were reassessed at program completion and at a later postprogram follow-up medical appointment and compared to baseline. Logistic regression analysis and the Mantel-Haenszel χ2 statistic were used to determine the effect of the CHW assignment on program completion. Analyses of covariance were performed with end-of-treatment behavior scores, knowledge scores, and glycohemoglobin levels as outcome variables, controlling for baseline values and testing for the effect of CHW assignment.

RESULTS Of 64 patients enrolled in the study, 40 (63%) completed and 24 (37%) dropped out before completing the diabetes education program. Of the patients having CHW intervention, 80% completed the education program, compared with 47% of patients without CHW intervention (P = 0.01). “Dropouts” were younger (age 47.5 ± 12.5 years [mean ± SD]) compared with patients who completed the program (55.9 ± 9.9 years) (P = 0.004). Dropout status showed no significant relationship to educational level achieved or literacy level. For the program “completers,” knowledge levels and selected self-care practices significantly improved, and glycohemoglobin levels improved from a baseline level of 11.7% to 9.9% at program completion (P = 0.004) and 9.5% at the postprogram follow-up (P < 0.001). The effect of the CHW assignment on program completion, controlling for financial status and language spoken, was extremely robust (P = 0.007). The effect of the CHW on knowledge, self-care behavior, or glycohemoglobin outcome variables was not statistically significant.

CONCLUSIONS These findings suggest that intervention with a bicultural CHW improved rates of completion of a diabetes education program in an inner-city Hispanic patient population irrespective of literacy or educational levels attained. Our data further suggests that completion of individualized diabetes educational strategies leads to improved patient knowledge, self-care behaviors, and glycemic control.

  • Received April 29, 1996.
  • Revision received October 16, 1996.
  • Accepted October 16, 1996.
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