Community health workers for patients with medical and behavioral health needs – Challenges and opportunities

Diabetes in Appalachia: providers' perspectives

BACKGROUND

Southeastern Appalachian Ohio has more than double the national average of diabetes and a critical shortage of healthcare providers. Paradoxically, there is limited research focused on primary care providers' experiences treating people with diabetes in this region. This study explored providers' perceived barriers to and facilitators for treating patients with diabetes in southeastern Appalachian Ohio.

METHODS

We conducted in-depth interviews with healthcare providers who treat people with diabetes in rural southeastern Ohio. Interviews were transcribed, coded, and analyzed via content and thematic analyses using NVivo 12 software (QSR International, Chadstone, VIC, Australia).

RESULTS

Qualitative analysis revealed four themes: (1) patients' diabetes fatalism and helplessness: providers recounted story after story of patients believing that their diabetes was inevitable and that they were helpless to prevent or delay diabetes complications. (2) Comorbid psychosocial issues: providers described high rates of depression, anxiety, incest, abuse, and post-traumatic stress disorder among people with diabetes in this region. (3) Inter-connected social determinants interfering with diabetes care: providers identified major barriers including lack of access to providers, lack of access to transportation, food insecurity, housing insecurity, and financial insecurity. (4) Providers' cultural understanding and recommendations: providers emphasized the importance of understanding of the values central to Appalachian culture and gave culturally attuned clinical suggestions for how to use these values when working with this population.

CONCLUSIONS

Evidence-based interventions tailored to Appalachian culture and training designed to increase the cultural competency and cultural humility of primary care providers may be effective approaches to reduce barriers to diabetes care in Appalachian Ohio.

Community health workers improving diabetes outcomes in a rural Appalachian population

Community health workers (CHWs) play a key role in the emerging health infrastructure. They are successful in identifying individual or family needs and matching resources to help overcome the social determinants of health, and the lack of trust in the health care system. This study captures the CHW experience as research assistants and evaluates the effectiveness of CHWs' health coaching and support in improving diabetes health outcomes. By being immersed in the culture and values of the population, CHWs offer research support to assure more representative client samples, increased adherence to study protocols, and in reducing attrition rates.