Training community health workers as diabetes educators for urban African Americans: value added using participatory methods

Abstract

Background: With growing use of Community Health Workers (CHWs) to reach underserved populations, there is a need for more information on training methods to prepare CHWs, particularly in a health educator role.

Objectives: To describe procedures used to recruit, train, and evaluate CHWs in Project Sugar 2, a randomized controlled trial of a nurse case manager and CHW team intervention designed to improve diabetes care and control in a sample of 542 urban African Americans with type 2 diabetes.

Methods: CHWs received a Core Training on guidelines and procedures, didactic diabetes self-management education, and research protocol training. However, barriers to CHW implementation of the intervention were encountered, including CHW attrition, job performance and satisfaction issues, low self-confidence in knowledge and skills as educators, difficulties with maintaining a large caseload, and inefficiencies experienced in conducting home visits. To address barriers, the initial training was modified and condensed. A supplemental training utilizing participatory methods was developed collaboratively by CHWs and trainers to facilitate CHWs' designing of intervention materials in their own words and contributing processes for intervention implementation and quality control.

Results: The supplemental training resulted in CHW retention, satisfaction, confidence in skills, and feelings of ownership of the intervention. Participant satisfaction with care received from the CHWs and the Project Sugar 2 intervention was rated as high by 97% and 93% of responders, respectively.

Conclusion: Core training in research intervention policies, procedures, and protocols, combined with an extended participatory training, led to effective preparation of laypersons to serve as CHWs.