Improving self-management skills and hemoglobin A1C through a community health worker intervention

The devastating effect of diabetes on personal health and healthcare systems has been widely documented in various peer review journals. These effects especially manifest at community health care centers in Los Angeles County—where low income families and uninsured populations are predominately served. The Health Education Department embarked on an internal study to capture the positive effect of health education (as provided by an in-house Community Health Worker) on clinical and non-clinical outcomes. A cohort of about 30 diabetic patients, including newly diagnosed and poorly-controlled cases, was tracked over a six month period. Before and after the study, each patient completed an evidence-based self-efficacy evaluation to determine their perceived confidence level in managing their chronic condition. During the study period, each patient received a minimum of four counseling sessions with a Community Health Worker (CHW). Sessions were conducted in a clinic setting and were generally face-to-face, lasting 60 to 90 minutes. During these sessions, patients learned a variety of topics relevant to diabetes care. CHWs followed up with patients via phone to monitor progress on self-management goals as well as to discuss barriers to making change. Once internal study concluded, we noted that self-efficacy scores significantly improved post intervention assessment. Also, more than half of the patients who received health education lowered or maintained their hemoglobin A1C. Based on these results, we infer that CHWs play a crucial role in educating and motivating patients to change health behaviors which in turn lead to improved clinical outcomes.