Implementation of a Culturally Tailored Diabetes Intervention With Community Health Workers in American Samoa. (November 2013)

• Record Type: Journal Article
• Authors: DePue, Judith D.; Rosen, Rochelle K.; Seiden, Andrew; Bereolos, Nicole; Chima, Marian L.; Goldstein, Michael G.; Nu'usolia, Ofeira; Tuitele, John; McGarvey, Stephen T.
• Is Part Of: Diabetes educator. Volume 39:Number 6(2013)
• Page Start: 761
• Page End: 771
• Publication Date: 2013-11
• Subjects: Diabetes -- Study and teaching -- Periodicals; 616.462005
• DOI: 10.1177/0145721713504630
• Languages: English
• ISSNs: 0145-7217

Abstract

Purpose: The purpose of this article is to answer key implementation questions from our translation research with a primary care–based, nurse–community health worker (CHW) team intervention to support type 2 diabetes self-management. Methods: Descriptive data are given on intervention delivery, CHW visit content, patient safety, and intervention costs, along with statistical analyses to examine participant characteristics of higher attendance at visits. Results: In the intervention sample (n = 104), 74% (SD = 16%) of planned intervention visits occurred, guided by an algorithm-based protocol. Higher risk participants had a significantly lower dose of their weekly assigned visits (66%) than those at moderate (74%) and lower risk (90%). Twenty-eight percent of participants moved to a lower risk group over the year. Estimated intervention cost was $656 per person. Participants with less education were more likely to attend optimal percentage of visits. Conclusions: A nurse-CHW team can deliver a culturally adapted diabetes self-management support intervention with excellent fidelity to the algorithm-based protocols. The team accommodated participants' needs by meeting them whenever and wherever they could. This study provides an example of adaptation of an evidence-based model to the Samoan cultural context and its resource-poor setting.