Nurse-Community Health Worker Team Improves Diabetes Care in American Samoa:: Results of a randomized controlled trial

• Autores: Judith D. DePue, Shira Dunsiger, Andrew D. Seiden, Jeffrey Blume, Rochelle K. Rosen, Michael G. Goldstein, Ofeira Nu'usolia, John Tuitele, Stephen T. McGarvey
• Localización: Diabetes care, ISSN-e 0149-5992, Vol. 36, Nº. 7, 2013, págs. 1947-1953
• Idioma: inglés
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• Resumen

  • 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. 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 wail-list control group that received usual care. Participants had a mean age of 55 years, 62% were female, mean years of education were 12.5 years, 41% were employed, and mean HbA^sub 1c^ was 9.8% at baseline. At 12 months, mean HbA^sub 1c^. 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 HbA^sub 1c^. 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. 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.