Short-term effect of motivational interviewing by trained community health workers on glycemic control in Korean immigrants with type 2 diabetes

Motivational interviewing (MI) is a form of patient-centered counseling tailored to the individual's readiness to change behavior. Though frequently used in substance abuse, MI has been adapted to address other health issues such as HIV, depression, and cardiovascular prevention. A limited body of evidence suggests that community health workers (CHWs) may be trained in MI to improve cardiovascular outcomes. However, no studies using MI by CHWs to date have demonstrated a reduction in glycemic control. Korean American (KIs) experience disproportionately higher rates of type 2 diabetes and lack of glycemic control than the mainstream population. The purpose of this paper is to test the effect of CHW-led MI on glycemic control among KAs with type 2 diabetes. A total of 215 KAIs (57% male; 47% uninsured; mean age=59 yrs) who were enrolled in an ongoing randomized behavioral intervention trial to promote self-management of type 2 diabetes, completed assessments at both baseline and 6 months (intervention, n=103; control, n=112). All participants had uncontrolled diabetes (hemoglobin A1C>7%) at baseline. The behavioral intervention program consists of 6-week in-class education followed by monthly MI counseling via telephone by trained CHWs for 12 months. Using repeated measures analysis of covariance, we found that the MI counseling by CHWs was effective in significantly lowering A1C and fasting glucose at 6 months. In addition, there were significant improvements in theoretically-selected psychosocial outcomes. The U.S. Affordable Care Act emphasizes implementation of evidence-based cost-efficient programs for disease prevention and health promotion, with a focus on reducing health disparities. Our findings suggest that using MI by trained CHWs is an innovative and potentially cost-efficient intervention strategy for better glycemic control in the recent KA community with limited resources. Adoption of this approach in other racial/ethnic minority communities is warranted to address racial/ethnic disparities in glycemic control in the U.S.