Cross-site evaluation of different community efforts to improve diabetes self-management among African-American women

Background: Starting in 2010, the Together on Diabetes (TOD) engaged five innovative approaches to improving diabetes self-management (DSME) among African-American women. The projects used somewhat distinct approaches to enhancing outreach and referral, quality of care, DSME and support, and community/system change. A participatory evaluation approach was used.

Methods: The aims of the evaluation were to: a) understand what is being accomplished within and among projects, b) improve performance, and c) assess the impacts of the initiative. This required engaging grantees in development of a logic model and key evaluation questions, systematically documenting the program and the impact of the intervention, and utilizing data for program improvement and decision making. The overall initiative: 1) developed an evaluation plan and online documentation and support system to monitor strategic approaches and accomplishments; 2) fully implemented participatory evaluation with all grantees; 3) conducted systematic reflection with project partners and foundation staff; and 4) presented a summative evaluation of the effort.

Results: The patterns across projects showed widespread use of DSME, predominantly delivered through community health workers, as well as differential use of social support integrated in health services. The five projects enrolled a total of 760 participants. Four of the five projects showed improvement in average A1c levels or in the proportion of participants at high risk (A1c > 9.0%).

Conclusions: Participatory evaluation can help implementation of key strategies and measure project impact. In this cross-site evaluation, strategies implemented by the TOD projects were associated with small to modest improvement in diabetes-related health outcomes.