Cherrington Andrea, Ayala Guadalupe X, Amick Halle, Allison Jeroan, Corbie-Smith Giselle, Scarinci Isabel
The School of Medicine, University of Alabama at Birmingham (Dr Cherrington, Dr Allison, Dr Scarinci)
Graduate School of Public Health, San Diego State University, California (Dr Ayala)
Diabetes Educ. 2008 Sep-Oct;34(5):824-33. doi: 10.1177/0145721708323643.
The purpose of this qualitative study was to examine methods of implementation of the community health worker (CHW) model within diabetes programs, as well as related challenges and lessons learned.
Semi-structured interviews were conducted with program managers. Four databases (PubMed, CINAHL, ISI Web of Knowledge, PsycInfo), the CDC's 1998 directory of CHW programs, and Google Search Engine were used to identify CHW programs. Criteria for inclusion were: DM program; used CHW strategy; occurred in United States. Two independent reviewers performed content analyses to identify major themes and findings. Sixteen programs were assessed, all but 3 focused on minority populations. Most CHWs were recruited informally; 6 programs required CHWs to have diabetes.
CHW roles and responsibilities varied across programs; educator was the most commonly identified role. Training also varied in terms of both content and intensity. All programs gave CHWs remuneration for their work. Common challenges included difficulties with CHW retention, intervention fidelity and issues related to sustainability. Cultural and gender issues also emerged. Examples of lessons learned included the need for community buy-in and the need to anticipate nondiabetes related issues.
Lessons learned from these programs may be useful to others as they apply the CHW model to diabetes management within their own communities. Further research is needed to elucidate the specific features of this model necessary to positively impact health outcomes.
本定性研究旨在探讨社区卫生工作者（CHW）模式在糖尿病项目中的实施方法，以及相关挑战和经验教训。
对项目管理人员进行了半结构化访谈。使用四个数据库（PubMed、CINAHL、ISI Web of Knowledge、PsycInfo）、疾病控制与预防中心（CDC）1998年的社区卫生工作者项目目录以及谷歌搜索引擎来识别社区卫生工作者项目。纳入标准为：糖尿病项目；采用社区卫生工作者策略；在美国开展。两名独立评审员进行了内容分析，以确定主要主题和研究结果。评估了16个项目，除3个项目外，其他项目均关注少数族裔人群。大多数社区卫生工作者是通过非正式方式招募的；6个项目要求社区卫生工作者患有糖尿病。
不同项目中社区卫生工作者的角色和职责各不相同；教育者是最常见的角色。培训在内容和强度方面也存在差异。所有项目都为社区卫生工作者的工作提供报酬。常见挑战包括社区卫生工作者的留用困难、干预的保真度以及与可持续性相关的问题。文化和性别问题也有所显现。经验教训的例子包括需要社区的支持以及需要预见到与糖尿病无关的问题。
这些项目的经验教训可能对其他将社区卫生工作者模式应用于自身社区糖尿病管理的人有用。需要进一步研究以阐明该模式对健康结果产生积极影响所必需的具体特征。
