RESUMO
Social needs contribute to persistent diabetes disparities; thus, it is imperative to address social needs to optimize diabetes management. The purpose of this study was to determine determine the feasibility and acceptability of health system-based social care versus social care + behavioral intervention to address social needs and improve diabetes self-management among patients with type 2 diabetes. Black/African American, Hispanic/Latino, and low-income White patients with recent hemoglobin A1C (A1C) ≥ 8%, and ≥1 social need were recruited from an integrated health system. Patients were randomized to one-of-two 6-month interventions: (a) navigation to resources (NAV) facilitated by a Patient Navigator; or (b) NAV + evidence-based nine-session diabetes self-management support (DSMS) program facilitated by a community health worker (CHW). A1C was extracted from the electronic health record. We successfully recruited 110 eligible patients (54 NAV; 56 NAV + DSMS). During the trial, 78% NAV and 80% NAV + DSMS participants successfully connected to a navigator; 84% NAV + DSMS connected to a CHW. At 6-month follow-up, 33% of NAV and 34% of NAV + DSMS participants had an A1C < 8%. Mean reduction in A1C was clinically significant in NAV (-0.65%) and NAV + DSMS (-0.72%). By follow-up, 89% of NAV and 87% of NAV + DSMS were successfully connected to resources to address at least one need. Findings suggest that it is feasible to implement a health system-based social care intervention, separately or in combination, with a behavioral intervention to improve diabetes management among a high-risk, socially complex patient population. A larger, pragmatic trial is needed to test the comparative effectiveness of each approach on diabetes-related outcomes.
Assuntos
Diabetes Mellitus Tipo 2 , Autogestão , Diabetes Mellitus Tipo 2/terapia , Hemoglobinas Glicadas , Comportamentos Relacionados com a Saúde , Humanos , Projetos PilotoRESUMO
INTRODUCTION: Racial/ethnic and socioeconomic disparities in diabetes prevalence and management persist. Unmet basic needs such as food insecurity and unstable housing interfere with optimal diabetes self-management. Bridge to Health/Puente a la Salud is a randomized pilot trial designed to examine the feasibility of testing the effectiveness of addressing unmet basic needs via navigation services versus navigation plus diabetes self-management support (DSMS) on improving diabetes-related outcomes among racial/ethnic minority and low-income patients with uncontrolled diabetes. MATERIAL AND METHODS: We recruited and randomized 110 African American, Hispanic, and Medicaid patients (any race/ethnicity) with diabetes and recent hemoglobin A1C ≥ 8% to one of two 6-month interventions: 1) Navigation only; or 2) Navigation + DSMS. In both arms, practice-embedded patient navigators help participants navigate social services and community-based resources to address unmet basic needs. In Navigation + DSMS, participants are also assigned to a community health worker (CHW) embedded in a local community-based organization who provides additional navigation support and delivers DSMS. A1C and unmet basic needs data are collected via routine lab and survey, respectively, at baseline and 6-month follow-up. Qualitative interviews with participants, health system leaders, CHWs, and patient navigators are conducted to explore intervention acceptability and determinants of implementation in a health care setting. DISCUSSION: Findings from this pilot feasibility study will enhance understanding about acceptability, preliminary clinical effectiveness, and facilitators and barriers to implementation of the Navigation only and Navigation + DSMS interventions and inform refinements of the overall study design for the larger, randomized clinical trial.
RESUMO
OBJECTIVE: The aim of this study was to evaluate the effectiveness of a 14-week Total Worker Health (TWH) intervention designed for construction crews. METHODS: Supervisors (nâ=â22) completed computer-based training and self-monitoring activities on team building, work-life balance, and reinforcing targeted behaviors. Supervisors and workers (nâ=â13) also completed scripted safety and health education in small groups with practice activities. RESULTS: The intervention led to significant (Pâ<â0.05) improvements in family-supportive supervisory behaviors (dâ=â0.72). Additional significant improvements included reported frequency of exercising 30âminutes/day and muscle toning exercise (dâ=â0.50 and 0.59), family and coworker healthy diet support (dâ=â0.53 and 0.59), team cohesion (dâ=â0.38), reduced sugary snacks and drinks (dâ=â0.46 and dâ=â0.46), sleep duration (dâ=â0.38), and objectively-measured systolic blood pressure (dâ=â0.27). CONCLUSION: A TWH intervention tailored for construction crews can simultaneously improve safety, health, and well-being.