Thompson Joan R, Horton Claire, Flores Carlos
La Clinica de La Raza, Oakland, California
Diabetes Educ. 2007 Jun;33 Suppl 6:159S-165S. doi: 10.1177/0145721707304077.
The purpose of this study was to pilot test the effectiveness of health promoters trained in the transtheoretical model of change to provide diabetes management education and support to Mexican Americans in a primary care setting.
The study site was an urban community health center in Oakland, California. This study reports on 142 patients who were enrolled for at least 1 year in the program. Community health workers acted as extenders of the medical staff to facilitate behavior change, using patient-centered counseling. This was a 1-group pretest/posttest pilot study. Descriptive statistics and the paired-sample t test were used to compare the change in clinical outcome measures from baseline to 6 months and 1 year. Statistically significant changes were correlated with frequency of community health worker contact.
The paired-sample t test showed significant reduction in glycosylated hemoglobin (HbA1c) from baseline to 1 year (P < .004). Reductions were also seen in low-density lipoprotein cholesterol and blood pressure, but they were not statistically significant. When stratified by gender, women showed a greater reduction in HbA1c than men at 1 year. Patients with a higher frequency of community health worker contact showed a greater decline in HbA1c level.
The pilot study demonstrates that community health workers, as an integral part of the health care team, are effective agents in providing self-management support to persons with diabetes.
本研究旨在对接受转变理论模型培训的健康促进者在初级保健环境中为墨西哥裔美国人提供糖尿病管理教育和支持的有效性进行初步测试。
研究地点为加利福尼亚州奥克兰的一家城市社区健康中心。本研究报告了142名参加该项目至少1年的患者。社区卫生工作者作为医务人员的延伸，通过以患者为中心的咨询来促进行为改变。这是一项单组前测/后测的初步研究。使用描述性统计和配对样本t检验来比较从基线到6个月和1年临床结局指标的变化。具有统计学意义的变化与社区卫生工作者的接触频率相关。
配对样本t检验显示从基线到1年糖化血红蛋白（HbA1c）显著降低（P < .004）。低密度脂蛋白胆固醇和血压也有所降低，但无统计学意义。按性别分层时，1年时女性的HbA1c降低幅度大于男性。社区卫生工作者接触频率较高的患者HbA1c水平下降幅度更大。
初步研究表明，社区卫生工作者作为医疗团队的一个组成部分，是为糖尿病患者提供自我管理支持的有效力量。
