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Gray KE, Hoerster KD, Taylor L, et al. Improvements in physical activity and some dietary behaviors in a community health worker-led diabetes self-management intervention for adults with low incomes: results from a randomized controlled trial. Transl Behav Med. 2021;11(12):2144-2154doi: 10.1093/tbm/ibab113.
Gray, K. E., Hoerster, K. D., Taylor, L., Krieger, J., & Nelson, K. M. (2021). Improvements in physical activity and some dietary behaviors in a community health worker-led diabetes self-management intervention for adults with low incomes: results from a randomized controlled trial. Translational behavioral medicine, 11(12), 2144-2154. https://doi.org/10.1093/tbm/ibab113
Gray, Kristen E, et al. "Improvements in physical activity and some dietary behaviors in a community health worker-led diabetes self-management intervention for adults with low incomes: results from a randomized controlled trial." Translational behavioral medicine vol. 11,12 (2021): 2144-2154. doi: https://doi.org/10.1093/tbm/ibab113
Gray KE, Hoerster KD, Taylor L, Krieger J, Nelson KM. Improvements in physical activity and some dietary behaviors in a community health worker-led diabetes self-management intervention for adults with low incomes: results from a randomized controlled trial. Transl Behav Med. 2021 Dec 14;11(12):2144-2154. doi: 10.1093/tbm/ibab113. PMID: 34424331.
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Transl Behav Med. 2021 Dec 14;11(12):2144-2154. doi: 10.1093/tbm/ibab113.

Improvements in physical activity and some dietary behaviors in a community health worker-led diabetes self-management intervention for adults with low incomes: results from a randomized controlled trial.

Translational behavioral medicine

Kristen E Gray, Katherine D Hoerster, Leslie Taylor, James Krieger, Karin M Nelson

Affiliations

  1. Department of Veterans Affairs, Health Services Research & Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.
  2. Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA.
  3. Mental Health Service, VA Puget Sound Healthcare System, Seattle Division, Seattle, WA, USA.
  4. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
  5. Healthy Food America, Seattle, WA, USA.
  6. Department of Medicine, University of Washington, Seattle, WA, USA.
  7. General Internal Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA.

PMID: 34424331 DOI: 10.1093/tbm/ibab113

Abstract

People with low incomes have a disproportionate prevalence of diabetes and its complications and experience many barriers to self-management, which community health workers (CHWs) may help address. We sought to examine the effects of an in-home CHW-led intervention for adults with diabetes and incomes <250% of the federal poverty line on self-management behaviors and test mediators and moderators. From 2010 to 2013, we randomized participants from three Washington State health systems with type 2 diabetes and hemoglobin A1c (HbA1c) ≥ 8% to the CHW intervention (N = 145) or usual care control (N = 142) arms. We examined effects on 12-month self-management: physical activity, dietary behaviors, medication taking, blood glucose monitoring, foot care, and tobacco use. For behaviors with significant intervention-control group differences, we tested mediation by self-efficacy and social support. We also investigated whether intervention-associated changes in behaviors varied by race/ethnicity, gender, and baseline values of HbA1c, diabetes distress, depression, and food insecurity (moderators). Compared to controls, intervention participants engaged in more physical activity and reported better dietary behaviors for some measures (general diet, frequency of skipping meals, and frequency of eating out) at 12-months, but there was no evidence of mediation by self-efficacy or social support. Evidence of moderation was limited: improvements in the frequency of skipping meals were restricted to participants with baseline HbA1c < 10%. Study findings suggest CHWs could be integrated into diabetes care to effectively support lifestyle changes around physical activity and some eating behaviors among adults with low incomes. More research is needed to understand mechanisms of change.

Published by Oxford University Press on behalf of the Society of Behavioral Medicine 2021.

Keywords: Community health workers; Diabetes mellitus; Diet; Exercise; Randomized controlled trial; Self-management; type 2

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Grant support