Diabetes Connect: African American men's perceptions of the community health worker model for diabetes care

Background: African Americans are disproportionately affected by the diabetes epidemic; they suffer greater diabetes-related complications and face more problems with diabetes self-management than non-Hispanic whites. Increasingly, the community health worker (CHW) model has been implemented in an effort to improve health outcomes in underserved populations. While diabetes CHW interventions in the literature have been successful, the majority of CHWs as well as the participants have been women. Further research is needed regarding men’s perceptions of how community-based interventions to  promote diabetes self-management might best be implemented. The purpose of this qualitative study is to explore how African American men living with type 2 diabetes perceive the role and duties of the community health worker in the context of a community-delivered diabetes management program.

Methods: Four ninety-minute focus groups were guided by a trained moderator with a written guide to facilitate discussion on the topic of community health workers (CHWs) and diabetes management. Participants were recruited from the diabetes education database at Cooper Green Mercy Hospital in Birmingham, AL.  Two independent reviewers performed content analysis to identify major themes using an iterative, combined deductive and inductive approach.

Results: There were 25 male participants. Mean years living with diabetes was 9.6 (range 1-20). Participants demonstrated knowledge of self-management strategies and identified various hardships including emotional and physical manifestations of diabetes, dietary restrictions and non-adherence, and institutional frustrations with the medical system that contributed to self-management barriers. Participants preferred CHWs be knowledgeable with a shared experience. Their preferred CHW duties were to educate, hold support groups, help track daily activities, and help find resources. Potential concerns regarding CHWs included cultural competency and confidentiality. The participants also discussed the importance of family-focused support dynamics.

Conclusions: Participants identified critical self-management strategies but endure hardships that present barriers to achieving these methods. Many of the strategies and barriers to self-management that participants identified mirrored their preferred CHW duties and traits. Results from this study suggest that African American men in Alabama would participate in and benefit from a community-delivered diabetes management program.