Corkery E, Palmer C, Foley M E, Schechter C B, Frisher L, Roman S H
Department of Nursing, Mount Sinai Medical Center, New York, New York 10029, USA.
Diabetes Care. 1997 Mar;20(3):254-7. doi: 10.2337/diacare.20.3.254.
To determine the effect of a bicultural community health worker (CHW) on completion of diabetes education in an inner-city Hispanic patient population and to evaluate the impact of completion of the education program on patient knowledge, self-care behaviors, and glycemic control.
Patients were randomized into CHW intervention and non-CHW intervention groups. All patients received individualized, comprehensive diabetes education from a certified diabetes nurse educator after baseline demographic information, diabetes knowledge, diabetes self-care practices, and glycohemoglobin levels were assessed. Rates of education program completion were determined. Diabetes knowledge, self-care practices, and glycohemoglobin levels were reassessed at program completion and at a later postprogram follow-up medical appointment and compared to baseline. Logistic regression analysis and the Mantel-Haenszel chi 2 statistic were used to determine the effect of the CHW assignment on program completion. Analyses of covariance were performed with end-of-treatment behavior scores, knowledge scores, and glycohemoglobin levels as outcome variables, controlling for baseline values and testing for the effect of CHW assignment.
Of 64 patients enrolled in the study, 40 (63%) completed and 24 (37%) dropped out before completing the diabetes education program. Of the patients having CHW intervention, 80% completed the education program, compared with 47% of patients without CHW intervention (P = 0.01). "Dropouts" were younger (age 47.5 +/- 12.5 years [mean +/- SD]) compared with patients who completed the program (55.9 +/- 9.9 years) (P = 0.004). Dropout status showed no significant relationship to educational level achieved or literacy level. For the program "completers," knowledge levels and selected self-care practices significantly improved, and glycohemoglobin levels improved from a baseline level of 11.7% to 9.9% at program completion (P = 0.004) and 9.5% at the postprogram follow-up (P < 0.001). The effect of the CHW assignment on program completion, controlling for financial status and language spoken, was extremely robust (P = 0.007). The effect of the CHW on knowledge, self-care behavior, or glycohemoglobin outcome variables was not statistically significant.
These findings suggest that intervention with a bicultural CHW improved rates of completion of a diabetes education program in an inner-city Hispanic patient population irrespective of literacy or educational levels attained. Our data further suggests that completion of individualized diabetes educational strategies leads to improved patient knowledge, self-care behaviors, and glycemic control.
确定具有两种文化背景的社区卫生工作者（CHW）对市中心西班牙裔患者群体完成糖尿病教育的影响，并评估完成教育计划对患者知识、自我护理行为和血糖控制的影响。
患者被随机分为CHW干预组和非CHW干预组。在评估了基线人口统计学信息、糖尿病知识、糖尿病自我护理实践和糖化血红蛋白水平后，所有患者均接受了来自认证糖尿病护士教育者的个性化、全面的糖尿病教育。确定教育计划的完成率。在计划完成时以及随后的计划后随访医疗预约时，重新评估糖尿病知识、自我护理实践和糖化血红蛋白水平，并与基线进行比较。使用逻辑回归分析和Mantel-Haenszel卡方统计量来确定CHW分配对计划完成的影响。以治疗结束时的行为评分、知识评分和糖化血红蛋白水平作为结果变量进行协方差分析，控制基线值并测试CHW分配的效果。
在纳入研究的64名患者中，40名（63%）完成了糖尿病教育计划，24名（37%）在完成前退出。接受CHW干预的患者中，80%完成了教育计划，而未接受CHW干预的患者中这一比例为47%（P = 0.01）。“退出者”比完成计划的患者更年轻（年龄47.5±12.5岁[均值±标准差]）（P = 0.004）。退出状态与所达到的教育水平或识字水平无显著关系。对于计划“完成者”，知识水平和选定的自我护理实践有显著改善，糖化血红蛋白水平从基线水平的11.7%在计划完成时降至9.9%（P = 0.004），在计划后随访时降至9.5%（P < 0.001）。在控制财务状况和所讲语言的情况下，CHW分配对计划完成的影响非常显著（P = 0.007）。CHW对知识、自我护理行为或糖化血红蛋白结果变量的影响无统计学意义。
这些发现表明，对具有两种文化背景的CHW进行干预可提高市中心西班牙裔患者群体完成糖尿病教育计划的比率，无论其识字水平或教育程度如何。我们的数据进一步表明，完成个性化糖尿病教育策略可改善患者知识、自我护理行为和血糖控制。
