Promotoras changing communities: Diabetes prevention and control

Objective: University of Texas Community Outreach (UTCO) is a community-based diabetes prevention and control program which utilizes promotoras (community health workers) to facilitate healthy lifestyles in Hispanic communities. Methods: Promotoras in four south Texas counties deliver education, nutrition, and physical activity classes for the community and disease self-management classes for diabetics. Cohort studies and a randomized intervention trial evaluate the health and economic impact of the program. Results: In year one, 26 promotoras guided 2,043 events comprising of 738 general diabetes education classes, 817 fitness activities, 313 nutrition classes and 170 self-management classes throughout the four counties. Among diabetics participating in promotora outreach programs, a community sample of 41 diabetics showed a 7.9% decrease in HbA1c (mean 8.9% vs. 8.2%, p<0.05) between baseline and 3-month follow-up and a clinic sample of 56 diabetics showed an 18.9% decrease in HbA1c (9.0% vs. 7.3%, p<0.01) between baseline and 3-month follow-up. In the clinic sample, diabetics with 6 to 15 months of follow-up maintained a mean HbA1c <7.0%. In the intervention trial, participants (n=1,132) who reported at least one contact with a promotora were 4.2 (95% CI 2.0-8.8) times more likely to meet physical activity guidelines of 150 minutes or more of weekly physical activity and 3.6 (95% CI 1.6-8.4) times more likely to eat fruit for dessert compared to participants who did not interact with a promotora controlling for age, gender, BMI and diabetic status. Conclusions: Initial results indicate a positive impact of the use of promotora outreach on diabetes prevention and control in Hispanic communities particularly for lifestyle changes. Further health impact results from the randomized intervention trial and cohort studies as well as the economic impact of the program will also be presented.