Nurse–Community Health Worker Team Improves Diabetes Care in American Samoa
Results of a randomized controlled trial
- Judith D. DePue, EDD, MPH1,2⇓,
- Shira Dunsiger, PHD1,2,
- Andrew D. Seiden, BA2,3,
- Jeffrey Blume, PHD4,
- Rochelle K. Rosen, PHD1,2,
- Michael G. Goldstein, MD5,
- Ofeira Nu’solia, MED6,
- John Tuitele, MBBS, MS6 and
- Stephen T. McGarvey, PHD, MPH2,3
- 1Centers for Behavioral and Preventive Medicine, the Miriam Hospital, Providence, Rhode Island
- 2Alpert Medical School at Brown University, Providence, Rhode Island
- 3International Health Institute & Department of Epidemiology, Public Health Program, Brown University, Providence, Rhode Island
- 4Vanderbilt University, Nashville, Tennessee
- 5VHA National Center for Health Promotion and Disease Prevention, Durham, North Carolina
- 6Tafuna Clinic, American Samoa Community Health Centers, Department of Health, American Samoa
- Corresponding author: Judith DePue,
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.
- © 2013 by the American Diabetes Association.
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