Nurse–Community Health Worker Team Improves Diabetes Care in American Samoa

Results of a randomized controlled trial

  1. Stephen T. McGarvey, PHD, MPH2,3
  1. 1Centers for Behavioral and Preventive Medicine, the Miriam Hospital, Providence, Rhode Island
  2. 2Alpert Medical School at Brown University, Providence, Rhode Island
  3. 3International Health Institute & Department of Epidemiology, Public Health Program, Brown University, Providence, Rhode Island
  4. 4Vanderbilt University, Nashville, Tennessee
  5. 5VHA National Center for Health Promotion and Disease Prevention, Durham, North Carolina
  6. 6Tafuna Clinic, American Samoa Community Health Centers, Department of Health, American Samoa
  1. Corresponding author: Judith DePue, jdepue{at}


OBJECTIVE To evaluate the effectiveness of a culturally adapted, primary care–based nurse–community health worker (CHW) team intervention to support diabetes self-management on diabetes control and other biologic measures.

RESEARCH DESIGN AND METHODS Two hundred sixty-eight Samoan participants with type 2 diabetes were recruited from a community health center in American Samoa and were randomly assigned by village clusters to the nurse-CHW team intervention or to a wait-list control group that received usual care.

RESULTS Participants had a mean age of 55 years, 62% were female, mean years of education were 12.5 years, 41% were employed, and mean HbA1c was 9.8% at baseline. At 12 months, mean HbA1c was significantly lower among CHW participants, compared with usual care, after adjusting for confounders (b = −0.53; SE = 0.21; P = 0.03). The odds of making a clinically significant improvement in HbA1c of at least 0.5% in the CHW group was twice the odds in the usual care group after controlling for confounders (P = 0.05). There were no significant differences in blood pressure, weight, or waist circumference at 12 months between groups.

CONCLUSIONS A culturally adapted nurse-CHW team intervention was able to significantly improve diabetes control in the U.S. Territory of American Samoa. This represents an important translation of an evidence-based model to a high-risk population and a resource-poor setting.

  • Received September 25, 2012.
  • Accepted January 2, 2013.

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