title: Nurse-community health worker team improves diabetes care in American Samoa: results of a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate the effectiveness of a culturally adapted, primary care-based nurse-community health worker (CHW) team intervention to support diabetes self-management on diabetes control and other biologic measures.
  
  
  METHODS
  Two hundred sixty-eight Samoan participants with type 2 diabetes were recruited from a community health center in American Samoa and were randomly assigned by village clusters to the nurse-CHW team intervention or to a wait-list control group that received usual care.
  
  
  RESULTS
  Participants had a mean age of 55 years, 62% were female, mean years of education were 12.5 years, 41% were employed, and mean HbA1c was 9.8% at baseline. At 12 months, mean HbA1c was significantly lower among CHW participants, compared with usual care, after adjusting for confounders (b = -0.53; SE = 0.21; P = 0.03). The odds of making a clinically significant improvement in HbA1c of at least 0.5% in the CHW group was twice the odds in the usual care group after controlling for confounders (P = 0.05). There were no significant differences in blood pressure, weight, or waist circumference at 12 months between groups.
  
  
  CONCLUSIONS
  A culturally adapted nurse-CHW team intervention was able to significantly improve diabetes control in the U.S. Territory of American Samoa. This represents an important translation of an evidence-based model to a high-risk population and a resource-poor setting.
authors: Centers for Behavioral and Preventive Medicine, the Miriam Hospital, Providence, Rhode Island, USA. jdepue@lifespan.org
authors: Judith D
authors: JD
authors: DePue
authors: Shira
authors: S
authors: Dunsiger
authors: Andrew D
authors: AD
authors: Seiden
authors: Jeffrey
authors: J
authors: Blume
authors: Rochelle K
authors: RK
authors: Rosen
authors: Michael G
authors: MG
authors: Goldstein
authors: Ofeira
authors: O
authors: Nu'usolia
authors: John
authors: J
authors: Tuitele
authors: Stephen T
authors: ST
authors: McGarvey
mesh_terms: D000328:Adult; D000368:Aged; D018948:American Samoa; D003150:Community Health Workers / Q000458:organization & administration*; D003924:Diabetes Mellitus, Type 2; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods
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