Diabetes Training for Community Health Workers

Effectiveness of Trained Community Lay Workers on Glycemic Control, Knowledge, and Self-Efficacy Among Agricultural Workers with Diabetes in the Texas Panhandle

Systemic health barriers, economic challenges, and lack of follow-up care exacerbate self-management of chronic diseases like diabetes among Hispanic agricultural workers. The primary objective of this pilot project was to determine the benefit of using community coaches to decrease A1C levels and increase diabetes knowledge among agricultural workers with diagnosed diabetes in the Texas Panhandle. A longitudinal study design with two phases was used to create, deliver, and evaluate a diabetes coaching program. Phase 1 was the development of the program and community coaches training (n = 4). In Phase 2, the coaches then delivered the program over 12 weeks to thirteen clients. Phase 1: All coaches were Hispanic females, 28.3 (SD 3.8) years of age, half had at most a high school education level and the other half had a vocational certification (n = 4). Mean DKQ-24 score was 54.2% (SD = 29.7) at baseline and 75.0% (SD = 31.4) after training (t (4) = 4.6, P < 0.05). We observed a very large difference between mean baseline and exit DKQ-24 scores relative to the pooled standard deviation, resulting in an effect size estimate of 0.59 indicative of a medium to large learning effect. Phase 2: Clients were Hispanic Spanish-speaking, predominantly female (55%), 44.4 (SD 6.8) years of age with at most a high school level of education (88.9%) and occupations varied from dairy farm worker (33.3%), meat processing worker (33.3%), and other agriculture or manufacturing position (33.3%). The mean SKILLD score was 40.0% (SD = 28.7) at baseline, increasing to 72.2% (SD = 25.4) at 12 weeks upon completion of the coaching program (t (9) = 2.956, P < 0.05). We observed a very large difference between mean baseline and exit SKILLD scores relative to the pooled standard deviation, resulting in an effect size estimate of 1.13 indicative of a large learning effect. The mean A1C levels at baseline screening was 8.3% (SD = 3.0) and 7.6% (SD = 3.0) at exit screening, representing a 0.7% decrease (p = 0.4730). No statistically significant differences were observed between depression (p = 0.786) or anxiety (p = 1.000) measures at baseline compared to exit. Training and coaching programs for hard-to-reach agricultural and meat processing workers must be culturally, linguistically, and literacy appropriate for both coaches and clients. The program must be feasible and sustainable, focus on empowering community members, capitalize on technological advances and persisting new-normals from the COVID-19 pandemic as well as dismantle common systemic barriers to health and understanding lived-experiences of agricultural working populations in rural regions.

Evaluation of a specialist nurse-led structured self-management training for peer supporters with type 2 diabetes mellitus with or without comorbid hypertension in Slovenia

BACKGROUND

The training of peer supporters is critical because the success of the entire peer support intervention depends on the knowledge and experience that peer supporters can share with other patients. The objective of this study was to evaluate the pilot implementation of a specialist nurse-led self-management training programme for peer supporters with type 2 diabetes mellitus (T2DM) with or without comorbid hypertension (HTN) at the primary healthcare level in Slovenia, in terms of feasibility, acceptability, and effectiveness.

METHODS

A prospective pre-post interventional pilot study was conducted in two Community Health Centres (CHC) in Slovenia from May 2021 to August 2022. Purposive sampling was employed to recruit approximately 40 eligible volunteers to become trained peer supporters. A specialist nurse-led structured training lasting 15 h over a 2-month period was delivered, comprising four group and two individual sessions. The comprehensive curriculum was based on interactive verbal and visual learning experience, utilising the Diabetes Conversation Maps™. Data were collected from medical records, by clinical measurements, and using questionnaires on sociodemographic and clinical data, the Theoretical Framework of Acceptability, knowledge of T2DM and HTN, and the Appraisal of Diabetes Scale, and evaluation forms.

RESULTS

Of the 36 participants, 31 became trained peer supporters (retention rate of 86.1%). Among them, 21 (67.7%) were women, with a mean age of 63.9 years (SD 8.9). The training was evaluated as satisfactory and highly acceptable. There was a significant improvement in knowledge of T2DM (p < 0.001) and HTN (p = 0.024) among peer supporters compared to baseline. Six months post-training, there was no significant improvement in the quality of life (p = 0.066), but there was a significant decrease in body mass index (BMI) (p = 0.020) from 30.4 (SD 6.2) at baseline to 29.8 (SD 6.2).

CONCLUSION

The pilot implementation of a specialist nurse-led self-management training for peer supporters was found to be feasible, acceptable, and effective (in the study group). It led to improvements in knowledge, maintained disease control, and promoted positive self-management behaviours among peer supporters, as evidenced by a decrease in their BMI over six months. The study emphasises the need for effective recruitment, training, and retention strategies.

TRIAL REGISTRATION

The research is part of the international research project SCUBY: Scale up diabetes and hypertension care for vulnerable people in Cambodia, Slovenia and Belgium, which is registered in ISRCTN registry ( https://www.isrctn.com/ISRCTN41932064 ).

Foot care intervention delivered by community health worker (CHWs): A scoping review

Variations of Community Health Workers (CHWs) interventions in diabetes self-management education (DSME) have been reviewed by many studies. In contrast, specific interventions regarding foot care intervention (FCI) are scarce and need to be explored further as one preventive measure to reduce diabetic foot problems in the community. This scoping review aimed to identify, and report nature of FCIs and the core components of FCIs delivered by CHWs. The scoping review was undertaken using PRISMA Extension for Scoping Reviews (PRISMA-ScR). The following electronic databases were searched for articles from data first indicated date through December 2022: CINAHL, EMBASE, Cochrane, Scopus, Web of Science, Theses ProQuest, PubMed, google scholar and other sources by using search terms related to foot care, community health workers, and diabetes mellitus. Descriptive synthesis was used to summarise the data. Nine studies from 1644 were included. All studies found that CHWs provided DSME in general, and foot care education was included. There was no detailed description of the core components of the intervention on foot care. Although, all studies might not provide detailed data on how CHW provided FCIs; the CHW intervention is an undoubtedly vital strategy to promote and prevent foot problems in medically underserved communities.

Understanding how and why upskilling programmes for unregulated care providers can support health equity in underserved communities: a realist review protocol

INTRODUCTION

Foot ulcers are one of the most devastating complications of diabetes mellitus leading to leg amputations. In Canada, systematically marginalised and racialised populations are more prone to developing foot ulcers and at higher risk of limb amputations. Shortages of regulated healthcare have hindered efforts to provide foot care. Upskilling unregulated care providers (UCPs) to deliver foot screening seems a reasonable solution to reduce limb loss. UCPs can advocate for health equity and deliver appropriate care. There is a need, however, to understand how and why an educational intervention for UCPs providing foot screening for these high-risk groups may or may not work.

METHODS AND ANALYSIS

This realist review will follow the Realist And Meta-narrative Evidence Syntheses: Evolving Standards standards. First, we will develop an initial programme theory (PrT) based on exploratory searches and discussions with experts and stakeholders. Then, we will search MEDLINE, Embase, PsycINFO, ERIC, CINAHL and Scopus databases along with relevant sources of grey literature. The retrieved articles will be screened for studies focusing on planned educational interventions for UCPs related to diabetic foot assessment. Data regarding contexts, mechanisms and outcomes will be extracted and analysed using a realist analysis through an iterative process that includes data reviewing and consultation with our team. Finally, we will use these results to modify the initial PrT.

ETHICS AND DISSEMINATION

Ethical approval is not required for this review. The main output of this research will be an evidence-based PrT for upskilling programmes for UCPs. We will share our final PrT using text, tables and infographics to summarise our results and draw insights across papers/reports. For academic, clinical, social care and educational audiences, we will produce peer-reviewed journal articles, including those detailing the process and findings of the realist review and establishing our suggestions for effective upskilling programmes.

PROSPERO REGISTRATION NUMBER

CRD42022369208.

Awareness and risk burden of diabetes mellitus in a rural community of Ekiti State, South-Western Nigeria

Objective

In recent times, Diabetes Mellitus (DM) has had a rapid increase in developing countries as a result of changing lifestyles among the people. This study was therefore aimed to investigate the level of awareness of DM and its associated risk factors in Afao: a rural community located in Irepodun/Ifelodun Local Government Ekiti State, Nigeria.

Design

The study was descriptive cross-sectional in design. A multi-stage sampling technique was applied to recruit respondents who are residents in the community. Two hundred and one individuals were involved in this community-based study. Information was obtained using a modified WHO STEPwise approach to chronic disease risk surveillance. The questionnaire included questions that assessed socio-demographic characteristics, diabetic risk factors and anthropometric measures of respondents.

Result

Of the 134 (66.7%) respondents aware of DM, only an average of 43.9% had knowledge of its risk factors. Respondent’s body mass index was significantly associated (P < 0.01) with knowledge of overweight/obesity as overweight (52.9%), grade 1 obese (62.5%) and morbid obese (100%) respondents had no knowledge of their status as risk factors for DM. Also, respondent’s blood pressure status showed a significant association (P = 0.099) with respondent’s knowledge of high blood pressure, 62.5% of those unaware of their blood pressure status had no knowledge of high blood pressure as a diabetes risk factor. Respondent’s age (P = 0.024) and diet; daily vegetable servings (P = 0.015) and cooking oil (P = 0.05) showed significant association with the occurrence of the disease in 14.4% respondents previously diagnosed.

Conclusion

This study shows a need to improve on the level of awareness of diabetes risk factors in Afao. Routine measurement of blood glucose levels for adults, community health education and enlightenment strategies through the ministry of health on the awareness of diabetes are highly recommended for the Afao community.

What Is the Impact of a Context-Specific Training Program for Home-Based Carers? An Evaluation Study

Introduction: In South Africa (SA), home-based carers (HBCs) play a crucial role at the community level for non-communicable diseases (NCDs) including diabetes mellitus (DM) public health care. The work of HBCs requires them to be knowledgeable about diabetes, and lack of knowledge has implications on their roles for the provision of health information and dietary advice. HBCs need to be provided with specific training to develop their knowledge and skills necessary to enable them to provide care to people with diabetes (PWD) because organizations need to benefit from a pool of well-trained HBCs. Therefore, a training program was developed to improve care for chronic conditions based on local needs. Aim: To implement and evaluate the training program for the HBCs for PWD in Ga-Dikgale village. Methods: HBCs working at Ga- Dikgale villages in four clinics—namely, Dikgale, Seobi Dikgale, Sebayeng, and Makotopong—participated voluntarily. Fifty-five (55) HBCs who attended the training program completed satisfaction survey tools, and furthermore, 45 HBCs completed both pre-training and post-training knowledge questionnaires. Training divided into two sessions which each lasted for two days was conducted. Satisfaction with the training, improvement of knowledge, and perceived impact on daily practice were evaluated using both qualitative and quantitative approaches. Results: Quantitative results indicate that 72% had poor knowledge of pre-training and only 9% post-training. They scored more in a post-test with the following differences: Post-test (mean = 6.00, SD = 1.26); pre-test (mean = 3.31, SD = 1.77). The t-test results indicated the difference to be significant, t = −9.241, p = 0.000. From the qualitative results, the themes that emerged during data analysis from group discussions were HBCs’ achievements from the training, challenges related to diabetes and diet, and suggestions for further training. Conclusions: A context-specific training increased diabetes knowledge among the HBCs for PWD. The results highlighted the importance of training in improving the knowledge of HBCs about the care of PWD. The improvement in diabetes knowledge among HBCs needs to be maintained and sustained to achieve major health benefits for PWD.

Shifting the Care of Type 2 Diabetes Mellitus from Hospital to Primary Health Care Institutions through an Educational Intervention for Health Care Professionals: An Example from Rural China

This study assessed the impact of an educational intervention on the knowledge, attitudes, and practice regarding Type 2 Diabetes Mellitus (T2DM) of Primary Health Care (PHC) professionals, as well as on the types of T2DM care services which they were able to provide. The intervention was carried out in collaboration with county hospitals. The study was conducted from 2015 to 2016 among 241 health care professionals in 18 township health centers and 55 village clinics in three counties in Jiangsu Province, randomly divided into an intervention group and a control group. Participants in the intervention group received professional skills training sessions and team communication and were involved in regular meetings. The control group followed the routine work plan. At one-year follow up, the diabetes knowledge score, practice score, and attitudes score were significantly higher in the intervention group than in the control group. A significantly higher proportion of health care professionals in the intervention group was able to provide services compared with the control group, for all types of services, except T2DM emergency treatment. The intervention among health care professionals in PHC had a positive impact on their professional diabetes skills, knowledge, attitudes, practices, and types of services they were able to provide, at one-year follow-up.

Evaluating the Training of Chinese-Speaking Community Health Workers to Implement a Small-Group Intervention Promoting Mammography

This study evaluated the training of Chinese American Community Health Workers (CHWs) to implement a small-group mammography video and discussion program as part of a randomized controlled trial that had the goal to increase adherence to mammography screening guidelines among Chinese American women. A total of 26 Chinese American CHWs in the metropolitan Washington DC area, Southern California, and New York City participated in a 4-h training workshop and completed surveys before and after the workshop to assess their knowledge regarding mammography screening guidelines and human subjects protection rules. The results showed significantly increased knowledge of mammography screening guidelines and human subjects protection rules (both p < 0.01) after the training. CHWs were also trained to lead a discussion of the video, including screening benefits and misconceptions. Forty-three audio recordings of discussions led by 13 active CHWs were transcribed and qualitatively analyzed to assess implementation fidelity. Ten out of 13 active CHWs fully addressed about 3 of the 5 benefit items, and 11 out of 13 CHWs fully addressed more than 5 of the 9 misconception items. Chinese CHWs can be trained to implement research-based intervention programs. However, a one-time training resulted in moderate adherence to the discussion protocol. Ongoing or repeat trainings throughout the intervention period may be needed to enhance implementation fidelity.

A Self-Management Training Intervention: Perceptions and Practices of Community Health Workers in South Africa

Background. While community health workers (CHWs) are increasingly being used as a strategy for increasing health care access, particularly in rural communities, interventions are needed to improve their skill sets in inspiring health behavior change, both for themselves and among their community clients. Self-management (SM) education interventions have shown to improve health behaviors and well-being. Purpose. This article reports on systematic, in-depth interviews conducted with rural CHWs in South Africa to understand (1) their motivation for participating in SM training, (2) skills gained from training and (3) perceived impact of training on CHW health behavior, both personally and as health professionals. Method. Nineteen rural CHWs who completed an SM training participated in face-to-face semistructured interviews. Transcripts were independently coded by two researchers using the thematic framework approach. Findings. CHWs felt empowered to change their health behavior by skills such as goal setting and action planning, and by growth in self-awareness and confidence. They expressed that their desire to help others motivated them to participate in SM training. Conclusion. SM training programs that address practice skill gaps hold promise in producing health behavior changes for rural CHWs and their clients.

Diabetes management training for female community health volunteers in Western Nepal: an implementation experience

Background

In the backdroup of a rapidly increasing burden of diabetes in Nepal, a community-based diabetes management program is implemented involving female community health volunteers (FCHVs) under the government run FCHVs program. FCHVs received an intensive one-week training workshop on prevention, control and management of diabetes. The training program was implemented and evaluated to enhance diabetes knowledge of FCHVs and matched according to their literacy level.

Methods

A range of teaching methods were applied, including desk review, active participation, lectures, presentations, discussions, role plays, demonstration and field test. Evaluation of the knowledge attained was done by testing before and after the workshop. Major milestones in the development of the training module were presented from desk review and ending in stakeholder’s participation in reviewing and revising the training package. The qualitative interview transcripts of FCHVs were analyzed thematically.

Results

A 5-day training package was developed through a desk review of interventions using community health workers (CHWs) on diabetes management from similar settings. Training module included home-based blood glucose monitoring and home-based health education on life style counselling delivered through a participatory learning approach. There were 20 participants with a mean age of 47 years (SD ± 5.7). The overall assessment of knowledge of diabetes before-after the training, evaluated by the Diabetes Knowledge Questionnaire (DKQ) showed increases in mean score from 40.4% before training to a mean score of 63.3% after training (Paired t-test: t = − 11.1, P < 0.001, and Wilcoxon test for paired samples: z = − 3.930, P = 0.0001). Focus group discussions (FGDs) revealed that FCHVs had a favorable perception of the training program’s effectiveness.

Conclusions

If FCHVs are appropriately trained they may be instrumental in providing counseling and screening for diabetes management in their communities.

Roles, responsibilities and characteristics of lay community health workers involved in diabetes prevention programmes: A systematic review

AIM

To examine the characteristics of community health workers (CHWs) involved in diabetes prevention programmes (DPPs) and their contributions to expected outcomes.

METHODS

Electronic databases including PubMed-MEDLINE, EBSCOHost, and SCOPUS/EMBASE were searched for studies published between January 2000 and March 2016. All studies that used CHWs to implement DPP in ≥18-year-old participants without diabetes but at high risk for developing the condition, irrespective of the study design, setting or outcomes measured, were included. Results were synthesized narratively.

RESULTS

Forty papers of 30 studies were identified. Studies were mainly community-based and conducted in minority populations in USA. Sample sizes ranged from 20 participants in a single community to 2369 participants in 46 communities. Although CHWs were generally from the local community, their qualifications, work experience and training received differed across studies. Overall the training was culturally sensitive and/or appropriate, covering topics such as the importance of good nutrition and the benefits of increased physical activity, communication and leadership. CHWs delivered a variety of interventions and also screened or recruited participants. The shared culture and language between CHWs and participants likely contributed to better programme implementation and successful outcomes.

CONCLUSIONS

The complexity of DPPs and the diverse CHW roles preclude attributing specific outcomes to CHW involvement. Nevertheless, documenting potential CHW roles and the relevant training required may optimise CHW contributions and facilitate their involvement in DPPs in the future.

Health effectiveness of community health workers as a diabetes self-management intervention

OBJECTIVE

To evaluate the health effectiveness of community health workers among three groups (intervention, attentional control and control groups) of Hispanic adults with uncontrolled (HbA1c >8%) type 2 diabetes mellitus.

METHODS

This was a randomized clinical trial involving 180 English- and Spanish-speaking Hispanic individuals with uncontrolled type 2 diabetes mellitus, 40-74 years of age, who received diabetes care at an outpatient, public, urban hospital. Repeated-measures analysis of variance was used to evaluate the effect of time and group on the primary outcome measure and secondary outcomes. Group differences in the percentage of participants achieving at least 1% reduction in HbA1c levels were assessed using chi-square tests.

RESULTS

Patients' ages ranged from 44 to 74 years, 40% were male, 97% preferred Spanish and seven Spanish-speaking countries were identified as country of origin. Relative to the control and attentional control groups, the intervention group showed greater HbA1c reduction from baseline to 12 months and was the group with the highest percentage of participants showing 1% or more HbA1c reduction.

CONCLUSION

Integration of community health workers improved disease control for patients with type 2 diabetes mellitus during the intervention phase. Peer-driven/interactive ways to sustain diabetes control need to be explored.