title: Rationale and design of the Miami Healthy Heart Initiative: a randomized controlled study of a community health worker intervention among Latino patients with poorly controlled diabetes.
abstract: BACKGROUND
  Type 2 diabetes mellitus disproportionately affects the Latino community. Latinos with diabetes are also less likely to have adequate control of cardiovascular risk factors such as cholesterol and blood pressure. Community health workers (CHWs) are increasingly being used to address various health disparity conditions, including diabetes. However, evidence of their effectiveness from randomized controlled trials is limited.
  
  
  METHODS
  The Miami Health Heart Initiative is a randomized controlled trial of 300 Latino patients with diabetes. Patients with hemoglobin A1c (HbA1c) ≥8.0% were recruited from Miami-Dade's public hospital system. At baseline, all patients underwent phlebotomy, physical examination, and a structured 90-minute research interview. They were then randomized to either usual care or a CHW intervention called Cariño. For participants in the Cariño arm of the study, CHW services included assistance with nonmedical social services, health education, and patient navigation in which the CHWs serve as a bridge between patients and the health care system. These services were delivered through home visits, phone calls, and group visits. At 12 months, all subjects had a follow-up examination. The primary outcomes at 1 year are changes in systolic blood pressure, low-density lipoprotein, and HbA1c. Secondary outcomes include medication adherence, medication intensification, diabetes self-efficacy, physical activity, and self-reported fruit and vegetable intake.
  
  
  CONCLUSIONS
  The Miami Healthy Heart Initiative is one of the first rigorously conducted randomized controlled trials to provide evidence on the impact of CHWs on diabetes intermediate outcomes among Latinos. If the data support our primary hypotheses, the study would lend added support to ongoing efforts to incorporate CHWs as part of our national efforts to reduce and ultimately eliminate health disparities.
authors.affiliation: Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL, USA ; Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA.
authors.forename: Olveen
authors.initials: O
authors.lastname: Carrasquillo
authors.affiliation: Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Patberg
authors.affiliation: Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL, USA.
authors.forename: Yisel
authors.initials: Y
authors.lastname: Alonzo
authors.affiliation: Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA.
authors.forename: Hua
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL, USA.
authors.forename: Sonjia
authors.initials: S
authors.lastname: Kenya
keywords: Hispanic; community health workers; health care disparities; health care support; randomized trial; type II diabetes