title: Integration of a promotora-led self-management program into a system of care.
abstract: The purpose of this article is to describe the integration of a promotora-led self-management component into a system of care and assess the influence of this program on indicators of metabolic control over time.
  
  
  
  Gateway Community Health Center is a federally qualified health center in Laredo, Texas, that serves a predominantly Hispanic population. Gateway integrated self-management support into care for people with diabetes by incorporating promotora-led self-management services into the clinic structure, operations, and patient visits. The self-management program included education, goal setting, depression screening with symptom follow-up, and support groups after course end. Indicators of metabolic control, HbA1c, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides were compared at baseline and at 12 months.
  
  
  
  The integration of promotora-led self-management services into the system of care allowed for continual improvements of self-management services in response to patient needs. Patients enrolled in the self-management course showed improved indicators of metabolic control that were sustained over time, and they reported a high level of goal achievement.
  
  
  
  The integration of the promotora-led self-management program into diabetes care at Gateway generated a system of referral, follow-up, feedback, and documentation that produced consistently high-quality clinical care.
authors.affiliation: The Department of Community Health, Prevention Research Center, Saint Louis University School of Public Health, St Louis, Missouri (Ms Joshu)
authors.forename: Corinne E
authors.initials: CE
authors.lastname: Joshu
authors.affiliation: Gateway Community Health Center, Laredo, Texas (Ms Rangel and Ms Garcia)
authors.forename: Lourdes
authors.initials: L
authors.lastname: Rangel
authors.affiliation: Gateway Community Health Center, Laredo, Texas (Ms Rangel and Ms Garcia)
authors.forename: Otila
authors.initials: O
authors.lastname: Garcia
authors.affiliation: The National Program Office of the Robert Wood Johnson Foundation Diabetes Initiative, Division of Health Behavior Research, Departments of Internal Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O’Toole)
authors.forename: Carol A
authors.initials: CA
authors.lastname: Brownson
authors.affiliation: The National Program Office of the Robert Wood Johnson Foundation Diabetes Initiative, Division of Health Behavior Research, Departments of Internal Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O’Toole)
authors.forename: Mary L
authors.initials: ML
authors.lastname: O'Toole
mesh_terms: D000368:Aged; D003151:Community Health Centers; D003863:Depression / Q000534:rehabilitation; D003920:Diabetes Mellitus / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D006293:Health Promotion; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D012648:Self Care; D012944:Social Support; D013781:Texas