As type 2 diabetes prevalence increases in the United States, the burden of diabetes falls more on groups with greater barriers to care, such as language and cultural differences, and lower economic resources. Healthy People 2010 targeted diabetes as one of six diseases for the elimination of racial and ethnic health disparities. These disparities extend to the US Territory of American Samoa, where the proportion of adults >18 years with diabetes was 19.6% in 2002, compared to 6.4% of US adults. There have been no reported diabetes interventions in Samoans in the US. The overall purpose of this application is to translate recent advances in diabetes care into clinical practice for the American Samoan community by improving methods of health care delivery and improve methods of diabetes self management. We will use the community health worker model to test an expanded diabetes care model. Community health workers (CHW) have frequently been used to serve as """"""""bridges"""""""" between health care services and patients in poor ethnic minority communities. CHW workers provide culturally appropriate health education and instrumental social support and facilitation, and even organization, of access to care, while also providing patient information to medical providers. We propose a clinical trial to test the effectiveness of a CHW and primary-care coordinated intervention to provide outreach, education and support to 352 type 2 diabetes patients and their families in American Samoa. The outcomes at a one-year follow-up will include glycosolated hemoglobin (HbA1c), cardiovascular disease risk factors, diet and exercise behaviors, and adherence to diabetes care guidelines. The intervention builds upon best clinical practices for diabetes care by translating effective strategies to American Samoans. The translation of good diabetes care there may offer a model that is potentially replicable in other ethnic minority populations suffering the burden of diabetes.
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