Study: Participants who used community health workers showed improvement in diabetes control

The prevalence of diabetes among Hispanic Americans is growing and their likelihood of being hospitalized for uncontrolled diabetes is two times greater than that of non-Hispanic Whites. Rather than a new drug, the prescription for controlling diabetes may be a person.

In the Mexican American Trial of Community Health Workers (MATCH) study, participants in the control group received bi-weekly diabetes education from a bilingual newsletter that was mailed to their homes. The other participants were visited in their homes by community health workers who followed a specific teaching curriculum.

After the first year of the study, participants that used community health workers showed a significant improvement over the control group in managing their Type 2 diabetes. An even greater improvement was seen after the second year of the study. Results of the study, which was conducted in Chicago, were published in the online version of the American Journal of Public Health on August 15.

"In many populations that experience health care inequality, frontline public health professionals, called community health workers, empower people to take better care of themselves while saving money in the health system," said Dr. Steven Rothschild, a preventive medicine and family practice physician at Rush University Medical Center.

Community health workers act as a liaison between doctors and nurses and community members. They not only provide health information, but also coach patients in how to apply the information at home and at work. Additionally, because they share the same culture and language and have knowledge of the community, they can more effectively engage minority populations to control chronic health conditions better than other methods.

"The key is helping people take action to live healthier lives," Dr. Rothschild said. "Community health care workers are already in some neighborhoods, but are widely under-used throughout the country. Anybody can change for a few weeks or a couple of months, but sustaining a lifestyle for a longer period of time is huge," Dr. Rothschild said. "Even though both groups received the same diabetes management information that they would get going to a health clinic, participants who were educated by a community health worker had better results than those who were not."

Although this study focused on Mexican Americans with Type 2 diabetes, it adds a rigorous randomized controlled trial to a body of research that shows that people with chronic conditions that require an independent behavioral lifestyle change can benefit more greatly from the use of community health care workers than from other methods.

"Our hope is that people will increasingly consider community health workers as an essential part of the health care team and that insurers will start to look at reimbursement possibilities as a strategy to reduce costs," said Dr. Rothschild. "Compared to the cost of medication, the salary and benefits for community health care workers is a modest investment that can improve health and reduce long-term costs."