142nd APHA Annual Meeting and Exposition

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IDecide/Decido Decision Aid: The role of community health workers in the development and delivery of a tailored, interactive, web-based decision aid to low-income Latino and African American adults with poorly controlled type 2 diabetes who received care at a federally qualified health center in Detroit

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 3:10 PM - 3:30 PM

Gloria Palmisano, BS, MA , REACH Detroit Partnership, Community Health & Social Services Center, Inc., Detroit, MI, MI
Angela Fagerlin, PhD , VA Health Services Research & Development Center of Excellence, University of Michigan, Ann Arbor, MI
Rebecca Mase, MSW , VA Center for Clinical Management Research, University of Michigan Medical School, Ann Arbor, MI
Hwajung Choi, PhD , Department of Internal Medicine, Univeristy of Michigan, Ann Arbor, MI
Lawrence C. An, MD , The Center for Health Communications Research (CHCR), University of Michigan, Ann Arbor, MI
Caroline Richardson, MD , University of Michigan Medical School, Ann Arbor, MI
Michael Spencer, PhD , School of Social Work, University of Michigan, Ann Arbor, MI
Michele Heisler, MD MPA , University of Michigan, Ann Arbor, MI
Claudia Guajardo , REACH Detroit Partnership, CHASS Center, Inc., Detroit, MI
Deliana Ilarraza-Montalvo , REACH Detroit Partnership, CHASS Center, Inc., Detroit, MI
Michael Anderson , REACH Detroit Partnership, CHASS Center, Inc., Detroit, MI
  
Background: Health care centers serving low-income, urban populations often lack resources to support medication decision-making among patients with poorly controlled diabetes. The extent to which outcomes are better when community health workers (CHWs) use tailored e-health tools rather than print materials with patients is not known. This study compares the effectiveness of CHWs in supporting diabetes medication decision making when using a tailored, interactive web-based tool (iDecide) versus using print educational materials.

 Methods: Academic and community partners used community-based participatory research and user-centered design to create a tailored, interactive diabetes decision aid delivered via iPad by CHWs. An RCT tested iDecide versus printed educational materials with 188 patients who had an A1c ≥7.5%, or who reported questions/concerns/difficulty taking diabetes medications. Participants received a 1-2 hour session with a CHW using either iDecide or printed materials and two follow-up calls.

 Results: CHW recommendations in developing iDecide contributed to the tool being linguistically and culturally appropriate, and tailored to the needs of target community. Of the 188 participants, 176 completed follow-up. Both groups significantly improved across most measures. iDecide participants reported greater improvements in diabetes distress compared to print materials group (p=0.002). Only iDecide participants had improvements in A1c from baseline (-0.4%, p=0.002) and were more likely to maintain or achieve an A1c<=7% (p<0.05), a high level of self-efficacy (p<0.01), and a low level of diabetes distress (p<0.01).

 Conclusion: Interactive, tailored web-based tools developed in collaboration with CHWs and delivered by CHWs may improve the effectiveness of CHW diabetes decision support and coaching.

Learning Areas:

Chronic disease management and prevention
Diversity and culture
Planning of health education strategies, interventions, and programs

Learning Objectives:
Identify and describe how CHW’s skills and knowledge contributed to the development and delivery of iDecide decision tool Discuss the design and methods of the iDecide diabetes intervention for Latinos and African Americans Identify and describe significant outcomes among intervention and comparison participants Discuss implications of methods and results for future CHW-led community-based interventions that use health information technology to deliver health education and promote diabetes self-management practices

Keyword(s): Community Health Workers and Promoters, Community-Based Research (CBPR)

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the project manager overseeing multiple federally funded grant projects of the REACH Detroit Partnership that addresses racial and ethnic health disparities in type 2 diabetes among Latinos and African Americans. In these endeavors I have gained expertice in the use of community health worker model and community-based participatory research methods to address chronic disease managment among low-income, urban populations.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4312.0: Interdisciplinary Approaches Among CHWs and Public Health Entities (a collaborative session by the CHW and PHEHP sections)