Randomized Controlled Trial of a Community Health Worker Self-Management Support Intervention Among Low-Income Adults With Diabetes, Seattle, Washington, 2010-2014.
Community health workers (CHWs) can improve diabetes outcomes; however, questions remain about translating research findings into practical low-intensity models for safety-net providers. We tested the effectiveness of a home-based low-intensity CHW intervention for improving health outcomes among low-income adults with diabetes.



Low-income patients with glycated hemoglobin A1c(HbA1c) of 8.0% or higher in the 12 months before enrollment from 3 safety-net providers were randomized to a 12-month CHW-delivered diabetes self-management intervention or usual care. CHWs were based at a local health department. The primary outcome was change in HbA1cfrom baseline enrollment to 12 months; secondary outcomes included blood pressure and lipid levels, quality of life, and health care use.



The change in HbA1cin the intervention group (n = 145) (unadjusted mean of 9.09% to 8.58%, change of -0.51) compared with the control group (n = 142) (9.04% to 8.71%, change of -0.33) was not significant (P = .54). In an analysis of participants with poor glycemic control (HbA1c>10%), the intervention group had a 1.23-point greater decrease in HbA1ccompared with controls (P = .046). For the entire study population, we found a decrease in reported physician visits (P < .001) and no improvement in health-related quality of life (P = .07) in the intervention group compared with the control group.



A low-intensity CHW-delivered intervention to support diabetes self-management did not significantly improve HbA1crelative to usual care. Among the subgroup of participants with poor glycemic control (HbA1c>10% at baseline), the intervention was effective.
VA Health Services Research and Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.|VA Puget Sound Health Care System, General Internal Medicine Service, Seattle, Washington.|University of Washington, School of Medicine, Seattle, Washington.|University of Washington, School of Public Health, Seattle, Washington.
Karin
K
Nelson
VA Health Services Research and Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.
Leslie
L
Taylor
VA Health Services Research and Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.|VA Puget Sound Health Care System, General Internal Medicine Service, Seattle, Washington.|University of Washington, School of Medicine, Seattle, Washington.
Julie
J
Silverman
VA Health Services Research and Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.|VA Puget Sound Health Care System, General Internal Medicine Service, Seattle, Washington.|University of Washington, School of Medicine, Seattle, Washington.
Meghan
M
Kiefer
VA Health Services Research and Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.|University of Washington, School of Medicine, Seattle, Washington.
Paul
P
Hebert
University of Washington, School of Medicine, Seattle, Washington.
Dan
D
Lessler
University of Washington, School of Medicine, Seattle, Washington.|University of Washington, School of Public Health, Seattle, Washington.|Public Health - Seattle and King County, Seattle, Washington.
James
J
Krieger
D000328:Adult; D000368:Aged; D003150:Community Health Workers; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty; D000073278:Self-Management; D014861:Washington / Q000453:epidemiology