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A randomized controlled trial of the effects of nurse case manager and community health worker team interventions in urban African-Americans with type 2 diabetes.

The objective of the study was to determine the effectiveness and cost-effectiveness of primary care and community-oriented interventions in managing HbA1c, blood pressure, and lipids, and reducing hospitalizations and emergency room visits over 2 years. We describe an ongoing, randomized controlled trial of 542 urban African-Americans with type 2 diabetes ages 25 years and older who are members of a university-affiliated managed-care organization in Baltimore, MD. The participants are 74% female, have a mean age of 58 years, and 35% have yearly incomes greater than 7500 US dollars. Participants were randomized to one of two intervention groups for a period of 2 years: (1) usual medical care plus minimal telephone intervention implemented by a trained lay health educator (control group) or (2) usual medical care plus intensive intervention implemented by a nurse case manager (NCM)/community health worker (CHW) team. The intensive NCM/CHW team executes individual plans of care using evidence-based algorithms that focus on traditional diabetes self-management, screening and management of diabetes-related complications, and social issues surrounding diabetes care. Face-to-face NCM visits are conducted in the clinic once per year and CHW visits are conducted in the participant's home one to three times per year, both with additional follow-up contacts as needed. Written and verbal feedback (when necessary) is provided to the participant's primary care physician. All participants are expected to attend a 24-month follow-up visit where data are collected by interviewers blinded to intervention assignment. As of May 1, 2003, recruitment is complete, interventions are being fully implemented, and 24-month follow-up visits are beginning. Baseline sociodemographic characteristics, health-care utilization, health behaviors, and clinical characteristics of the study population are reported. This study is designed to test the hypothesis that a primary-care-based NCM plus CHW team approach is an effective, practical, and economically feasible strategy for translating current knowledge about type 2 diabetes into high-quality health care for urban African-Americans.

Black or African American↗

Pakistan's community health workers.

Pakistan's health characteristics are worse than those of other Asian countries at similar stages of development. Its mortality rate for children under five is 139 per 1,000, and its maternal mortality is 60 per 10,000. Malnutrition in women and children is widespread; 50 per cent of children under five are stunted. Pakistan's population growth rate of 3.1 per cent per year is among the highest in Asia. The high population growth rate and poor health status of many people call for extensive health care services, but, unfortunately, health services do not reach most of the people of Pakistan. Partly because the training of doctors and nurses is lengthy and expensive, there is an acute shortage of health care providers, especially women. Although female health professionals are preferred for caring for women, cultural constraints inhibit women from seeking education. Such is the multifaceted dilemma in the provision of primary health care in Pakistan.

Community Health Workers↗

Detroit's East Side Village Health Worker Partnership: community-based lay health advisor intervention in an urban area.

In recent years, there have been few reports in the literature of interventions using a lay health advisor approach in an urban area. Consequently, little is known about how implementation of this type of community health worker model, which has been used extensively in rural areas, may differ in an urban area. This article describes the implementation of the East Side Village Health Worker Partnership, a lay health advisor intervention, in Detroit, Michigan, and notes how participatory action research methods and principles for community-based partnership research are being used to guide the intervention. Findings are presented on how the urban context is affecting the design and implementation of this intervention. Implications of the findings for health educators are also presented and include the utility of a participatory action research approach, the importance of considering the context and history of a community in designing a health education intervention, and the importance of recognizing and considering the differences between rural and urban settings when designing a health education intervention.

Adult↗

Buddhist monks as community health workers in Thailand.

In Thailand, Buddhist monks and temples are scattered throughout the country even in the rural poor. There are approximately one temple and four monks for every two villages of about 1000 people. If Buddhist monks are able to expand their roles to health care and education, Buddhist temples will automatically become community health posts and 'Health for All by The Year 2000' will be achieved within 5-10 years in Thailand. Therefore, a volunteer monk-training program has been carried out and about 2000 graduates have returned to their community to disseminate primary health care. However, a systematic and 'industrialized' approach is necessary to get some visible impact on the health of the rural Thai population.

Buddhism↗

Community health workers in a Peruvian slum area: an evaluation of their impact on health behavior.

In 1986 the authors conducted a survey examining the performance of health promoters in Pucallpa, Peru, three years after an initial Danish project for training and supervising those promoters ended. The survey found that some two-fifths of the promoters were still active, that increased stress had been placed on curative tasks, and that the promoters appeared to have had their greatest impact in the areas of vaccination coverage and increased use of the available public health care service. No significant changes were found in the affected population's treatment of diarrhea or improvement of drinking water quality.

Adult↗

Evaluation of the WHO Haemoglobin Colour Scale for diagnosis of anaemia in children and pregnant women as used by primary health care nurses and community health workers in western Kenya.

OBJECTIVES: To evaluate the diagnostic accuracy of the WHO Haemoglobin Colour Scale (HCS) for anaemia in three groups of children aged 2 months to 2 years (sick children, those visiting an immunization clinic and a community-based random sample of children) and a sample of pregnant women. METHODS: Finger-prick blood samples were taken from all consenting participants. Haemoglobin (Hb) levels from the HCS were compared with results from a HemoCue portable haemoglobinometer. Sensitivity, specificity and positive and negative predictive values for the HCS were calculated. RESULTS: A total of 457 sick children, 336 children visiting immunization clinics, 454 children from the community at large and 643 pregnant women participated. The prevalence of anaemia (Hb<11 g/dl) in these groups was 87%, 79%, 74% and 52%, respectively. The prevalence of severe anaemia (Hb<7 g/dl) was 24%, 11%, 10% and 2%, respectively. The sensitivity of the HCS for anaemia ranged from 60% to 79% and specificity from 59% to 94%. The sensitivity of the HCS for severe anaemia ranged from 24% to 63% and the specificity from 97% to 100%. Through use of the HCS, the proportion of sick, anaemic children visiting peripheral health facilities diagnosed and treated for anaemia would increase from 3% to 65%. CONCLUSIONS: In an area with high prevalence of anaemia among sick children, use of the HCS has the potential to significantly increase the proportion of sick, anaemic children who are diagnosed with anaemia and given appropriate treatment. Further evaluations of the effect of the use of the HCS on treatment practices at the health facility level are required.

Adolescent↗