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Effectiveness of community health workers in the care of persons with diabetes

Authors

  • S. L. Norris,

    1. Department of Medical Informatics and Clinical Epidemiology, Oregon Health Sciences University, Portland, OR, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA,
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  • F. M. Chowdhury,

    1. Department of Medical Informatics and Clinical Epidemiology, Oregon Health Sciences University, Portland, OR, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA,
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  • K. Van Le,

    1. Cedars Sinai Medical Center, Los Angeles, CA and
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  • T. Horsley,

    1. Department of Medical Informatics and Clinical Epidemiology, Oregon Health Sciences University, Portland, OR, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA,
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  • J. N. Brownstein,

    1. Division for the Prevention of Heart Disease and Stroke, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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  • X. Zhang,

    1. Department of Medical Informatics and Clinical Epidemiology, Oregon Health Sciences University, Portland, OR, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA,
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  • L. Jack Jr,

    1. Department of Medical Informatics and Clinical Epidemiology, Oregon Health Sciences University, Portland, OR, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA,
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  • D. W. Satterfield

    1. Department of Medical Informatics and Clinical Epidemiology, Oregon Health Sciences University, Portland, OR, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA,
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  • The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

: Dawn W. Satterfield RN, PhD, Division of Diabetes Translation, Centers for Disease Control and Prevention, MS K-10, 4770 Buford Highway NE, Atlanta, GA 30341, USA. E-mail: dxs9@cdc.gov

Abstract

Aims  The purpose of this systematic review was to examine the effectiveness of community health workers in supporting the care of persons with diabetes.

Methods  Computerized searches were conducted of multiple electronic bibliographic dababases until March 2004. We identified studies in any language and of any design that examined the effectiveness of diabetes-related interventions involving community health workers and reported outcomes in persons with diabetes. Results were synthesized narratively.

Results  Eighteen studies were identified, including eight randomized controlled trials. Most studies focused on minority populations in the USA. The roles and duties of community health workers in diabetes care were varied, ranging from substantial involvement in patient care to providing instrumental assistance in education sessions taught by other health professionals. Participants were generally satisfied with their contacts with community health workers and participant knowledge increased. Improvements in physiological measures were noted for some interventions and positive changes in lifestyle and self-care were noted in a number of studies. There were few data on economic outcomes, but several studies demonstrated a decrease in inappropriate health care utilization.

Conclusions  Diabetes programmes include community health workers as team members in a variety of roles. There are some preliminary data demonstrating improvements in participant knowledge and behaviour. Much additional research, however, is needed to understand the incremental benefit of community health workers in multicomponent interventions and to identify appropriate settings and optimal roles for community health workers in the care of persons with diabetes.

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