title: A Community Health Worker Intervention for Diabetes Self-Management Among the Tz'utujil Maya of Guatemala.
abstract: Despite the high prevalence of diabetes in rural Guatemala, there is little education in diabetes self-management, particularly among the indigenous population. To address this need, a culturally relevant education intervention for diabetic patients was developed and implemented in two rural communities in Guatemala. An evaluative research project was designed to investigate if the structured, community-led diabetes self-management intervention improved selected health outcomes for participants. A one-group, pretest-posttest design was used to evaluate the effectiveness of the educational intervention by comparing measures of health, knowledge, and behavior in patients pre- and postintervention. A survey instrument assessed health beliefs and practices and hemoglobin A1c (HgA1c) measured blood glucose levels at baseline and 4 months post initiation of intervention (n = 52). There was a significant decrease (1.2%) in the main outcome measure, mean HgA1c from baseline (10.1%) and follow-up (8.9%; p = .001). Other survey findings were not statistically significant. This study illustrates that a culturally specific, diabetes self-management program led by community health workers may reduce HgA1c levels in rural populations of Guatemala. However, as a random sample was not feasible for this study, this finding should be interpreted with caution. Limitations unique to the setting and patient population are discussed in this article.
authors.affiliation: Emory University, Atlanta, GA, USA Mary.Micikas@gmail.com.
authors.forename: Mary
authors.initials: M
authors.lastname: Micikas
authors.affiliation: Emory University, Atlanta, GA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Foster
authors.affiliation: Emory University, Atlanta, GA, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Weis
authors.affiliation: Duke University Medical Center, Durham, NC, USA.
authors.forename: Alyse
authors.initials: A
authors.lastname: Lopez-Salm
authors.affiliation: Medical Anthropologist, Atlanta, GA, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Lungelow
authors.affiliation: Organization for the Development of the Indigenous Maya, San Juan La Laguna, Guatemala.
authors.forename: Pedro
authors.initials: P
authors.lastname: Mendez
authors.affiliation: Organization for the Development of the Indigenous Maya, San Juan La Laguna, Guatemala.
authors.forename: Ashley
authors.initials: A
authors.lastname: Micikas
mesh_terms: D003153:Community Health Services / Q000379:methods*; D003150:Community Health Workers / Q000193:education; D003159:Community-Institutional Relations; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D005845:Georgia; D006442:Glycated Hemoglobin / Q000032:analysis; D006166:Guatemala; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006293:Health Promotion / Q000379:methods*; D006306:Health Surveys; D006441:Hemoglobin A / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007197:Indians, Central American / Q000523:psychology*; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D012424:Rural Population; D012577:Schools, Medical; D012648:Self Care
chemical_list: D006442:Glycated Hemoglobin; D006441:Hemoglobin A; D007004:Hypoglycemic Agents; D008687:Metformin
keywords: chronic disease; diabetes; health education; health promotion; international/cross-cultural health