Diabetes is a major problem among Mexican-Americans, the most rapidly growing segment of the US population. Hispanics have higher prevalence rates of diabetes than non-Hispanic whites and experience excess morbidity and mortality. Hispanics are 1.45 times more likely to die of diabetes complications than non-Hispanic whites. Evidence suggests that diabetes complications can be reduced through control of fasting blood sugar and blood pressure. Trials show that self-management behaviors (self monitoring of blood glucose, taking medications as prescribed, and periodic scheduled clinic attendance) can make a positive difference in achieving these outcomes. Among Mexican-Americans, however, cultural, logistical, linguistic, and environmental barriers result in lower documented rates of self-management behaviors. Although behavioral interventions to improve self-management have shown promise in improving self care and metabolic outcomes, very little attention has been paid to the unique cultural barriers faced by Hispanics or to ways of overcoming these barriers to achieve successful self-management. The MATCH study (Mexican-American Trial of Community Health Workers) will test the hypothesis that the use of indigenous Community Health Workers (CHWs), recruited from the target community and trained to provide culturally appropriate diabetes education, can promote pro-active self-management among inner-city dwelling Mexican-Americans with Type2 diabetes mellitus. The study aims are to demonstrate that a CHW, compared to an attention control, will: 1) result in improvement in short term physiologic outcomes (Hemoglobin Alc levels and blood pressure), and 2) result in increased frequency of three self-management behaviors (daily self blood-glucose monitoring, medication taking, and clinic follow-up). Study design is a partially blinded, randomized controlled trial of 154 patients with Type 2 diabetes mellitus, recruited from among enrollees in a large open-panel HMO health plan. Participants must reside in one of two targeted inner city neighborhoods, and must be Mexican or Mexican- American. Participants will be randomized to an experimental group to receive twice-monthly home visits from a CHW for diabetes education and self-management skills training, or to an attention control. Four self-management skills (self-monitoring, environmental restructuring, involvement of the social environment, and problem-solving) will be applied to the 3 self-care behavioral outcomes. Future translation of this research will be facilitated by a well-standardized intervention and rigorous monitoring of CHW encounters through audiotapes and documentation of intervention worksheets. ? ?

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Project (R01)
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Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
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Garfield, Sanford A
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Rush University Medical Center
Public Health & Prev Medicine
Schools of Medicine
United States
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Rothschild, Steven K; Martin, Molly A; Swider, Susan M et al. (2014) Mexican American trial of community health workers: a randomized controlled trial of a community health worker intervention for Mexican Americans with type 2 diabetes mellitus. Am J Public Health 104:1540-8
Rothschild, Steven K; Martin, Molly A; Swider, Susan M et al. (2012) The Mexican-American Trial of Community Health workers (MATCH): design and baseline characteristics of a randomized controlled trial testing a culturally tailored community diabetes self-management intervention. Contemp Clin Trials 33:369-77
Martin, Molly A; Swider, Susan M; Olinger, Tamara et al. (2011) Recruitment of Mexican American adults for an intensive diabetes intervention trial. Ethn Dis 21:7-12
Swider, Susan M; Martin, Molly; Lynas, Carmen et al. (2010) Project MATCH: training for a promotora intervention. Diabetes Educ 36:98-108