Mexican American trial of community health workers: a randomized controlled trial of a community health worker intervention for Mexican Americans with type 2 diabetes mellitus.

OBJECTIVES: We assessed whether community health workers (CHWs) could improve glycemic control among Mexican Americans with diabetes. METHODS: We recruited 144 Mexican Americans with type 2 diabetes between January 2006 and September 2008 into the single-blinded, randomized controlled Mexican American Trial of Community Health Workers (MATCH) and followed them for 2 years. Participants were assigned to either a CHW intervention, delivering self-management training through 36 home visits over 2 years, or a bilingual control newsletter delivering the same information on the same schedule. RESULTS: Intervention participants showed significantly lower hemoglobin A1c levels than control participants at both year 1 Δ = -0.55; P = .021) and year 2 (Δ = -0.69; P = .005). We observed no effect on blood pressure control, glucose self-monitoring, or adherence to medications or diet. Intervention participants increased physical activity from a mean of 1.63 days per week at baseline to 2.64 days per week after 2 years. CONCLUSIONS: A self-management intervention delivered by CHWs resulted in sustained improvements in glycemic control over 2 years among Mexican Americans with diabetes. MATCH adds to the growing body of evidence supporting the use of CHWs to reduce diabetes-related health disparities.

The Mexican-American Trial of Community Health workers (MATCH): design and baseline characteristics of a randomized controlled trial testing a culturally tailored community diabetes self-management intervention.

OBJECTIVES: Community Health Workers (CHWs) have been recommended to reduce diabetes disparities, but few robust trials of this approach have been conducted. Limitations of prior studies include: unspecified a priori outcomes; lack of blinded outcome assessments; high participant attrition rates; and lack of attention to intervention fidelity. These limitations reflect challenges in balancing methodologic rigor with the needs of vulnerable populations. The Mexican-American Trial of Community Health workers (MATCH) was a blinded randomized controlled trial testing CHW efficacy in improving physiologic outcomes and self-management behaviors among Mexican-Americans with type 2 diabetes. This paper describes methods used to overcome limitations of prior studies. RESEARCH DESIGN AND METHODS: The primary aim was to determine if a CHW intervention would result in significant reductions in Hemoglobin A1c and rates of uncontrolled blood pressure. 144 Mexican-Americans with diabetes were randomized. The intervention consisted of self-management training delivered by CHWs over a 24-month period; the comparison population received identical information via bilingual newsletter. Blinded research assistants completed assessments at baseline, 12 months, and 24 months post-randomization. RESULTS: The MATCH cohort was characterized by low acculturation and socioeconomic status. Study participants had low rates of medication adherence and glucose monitoring. 70% had poor glycemic control with A1c levels over 7.0, and 57.3% had blood pressures worse than ADA target levels (<130/80). CONCLUSIONS: MATCH preserved community sensitivity and methodologic rigor. The study's attention to intervention fidelity, behavioral attention control, blinded outcomes assessment, and strategies to enhance participant retention can be replicated by researchers testing culturally-tailored CHW interventions.

Recruitment of Mexican American adults for an intensive diabetes intervention trial.

OBJECTIVE: Effective behavioral diabetes interventions for Mexican Americans are needed. Our study focused on efforts to recruit Mexican American adults for a trial testing a diabetes community health worker (CHW) self-management intervention. DESIGN: Behavioral randomized controlled trial, community-based participatory research approach. SETTING: Chicago. PARTICIPANTS: Mexican American adults with type 2 diabetes. OUTCOME MEASURES: Screening and randomization. METHODS: Initial eligibility criteria included Mexican heritage, treatment with oral diabetes medication, residence in designated zip codes, planned residence in the area for two years, and enrollment in a specific insurance plan. RESULTS: Recruitment through the insurer resulted in only one randomized participant. Eligibility criteria were relaxed and subsequent efforts included bilingual advertisements, presentations at churches and community events, postings in clinics, partnerships with community providers, and CHW outreach. Zip codes were expanded multiple times and insurance criteria removed. CHW outreach resulted in 53% of randomized participants. CONCLUSIONS: Despite strong ties with the target community, culturally appropriate recruitment strategies involving community representation, and a large pool of potential participants, significant challenges were encountered in recruitment for this diabetes intervention trial. Researchers identified three key barriers to participation: study intensity and duration, lack of financial incentives, and challenges in establishing trust. For future research to be successful, investigators need to recognize these barriers, offer adequate incentives to compensate for intervention intensity, and establish strong trust through community partnerships and the incorporation of community members in the recruitment process.