title: EMPOWER: a randomized trial using community health workers to deliver a lifestyle intervention program in African American women with Type 2 diabetes: design, rationale, and baseline characteristics.
abstract: BACKGROUND
  African American (AA) women with Type 2 diabetes mellitus (T2DM) in the rural south experience less weight loss and poorer glycemic control in traditional diabetes management programs compared to Caucasians. This paper describes the design, rationale, and baseline characteristics from an innovative community health worker (CHW) delivered intervention program in this population.
  
  
  METHODS
  This prospective trial randomized rural AA women with uncontrolled T2DM (HbA1c ≥ 7.0) to receive a behaviorally-centered, culturally-tailored lifestyle intervention during 16 contacts from a trained AA CHW or 16 approved diabetes educational mailings. Changes from baseline in glycosylated hemoglobin levels (HbA1c), blood pressure (BP), weight, body mass index (BMI), self-reported dietary and physical activity patterns, and psychosocial measures including diabetes distress, empowerment, depression, self-care, medication adherence, and life satisfaction will be assessed at 6- and 12-months.
  
  
  RESULTS
  Two hundred AA women (mean age = 53.09 ± 10.89 years) with T2DM from impoverished rural communities were enrolled. Baseline data demonstrated profoundly uncontrolled diabetes of long term duration (mean HbA1c = 9.11 ± 1.82; mean BMI = 37.68 ± 8.20; mean BP = 134.51 ± 20.39/84.19 ± 11.68; 10.5 ± 0.7 years). Self-care behavior assessment revealed poor dietary and medication adherence and sedentary lifestyle. Most psychosocial measures ranged within normal limits.
  
  
  CONCLUSIONS
  The present sample of AA women from impoverished rural communities exhibited significantly uncontrolled T2DM of long duration with associated obesity and poor lifestyle behaviors. An innovative CHW led lifestyle intervention may lead to more effective strategies for T2DM management in this population.
authors.affiliation: Department of Family Medicine, East Carolina University, Brody School of Medicine, Greenville, NC 27834, USA. cummingsd@ecu.edu
authors.forename: Doyle M
authors.initials: DM
authors.lastname: Cummings
authors.forename: Lesley D
authors.initials: LD
authors.lastname: Lutes
authors.forename: Kerry
authors.initials: K
authors.lastname: Littlewood
authors.forename: Emily
authors.initials: E
authors.lastname: Dinatale
authors.forename: Bertha
authors.initials: B
authors.lastname: Hambidge
authors.forename: Kathleen
authors.initials: K
authors.lastname: Schulman
mesh_terms: D000328:Adult; D001741:Black or African American; D001786:Blood Glucose; D003150:Community Health Workers / Q000458:organization & administration*; D054521:Cultural Competency; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology* / Q000628:therapy*; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008019:Life Style; D055118:Medication Adherence; D008875:Middle Aged; D010353:Patient Education as Topic / Q000458:organization & administration*; D011204:Poverty Areas; D011446:Prospective Studies; D011788:Quality of Life; D012424:Rural Population; D012648:Self Care; D012959:Socioeconomic Factors; D015144:Southeastern United States / Q000453:epidemiology; D015431:Weight Loss
chemical_list: D001786:Blood Glucose
keywords: African-American; Community health worker; Lifestyle changes; Type 2 diabetes