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. 2018 Feb 15;3(1):e000566.
doi: 10.1136/bmjgh-2017-000566. eCollection 2018.

Community health workers improve disease control and medication adherence among patients with diabetes and/or hypertension in Chiapas, Mexico: an observational stepped-wedge study

Patrick M Newman  1 , Molly F Franke  2 , Jafet Arrieta  3 , Hector Carrasco  3 , Patrick Elliott  4 , Hugo Flores  5 , Alexandra Friedman  6 , Sophia Graham  7 , Luis Martinez  8 , Lindsay Palazuelos  9 , Kevin Savage  2 , Hayley Tymeson  10 , Daniel Palazuelos  5
Affiliations

Community health workers improve disease control and medication adherence among patients with diabetes and/or hypertension in Chiapas, Mexico: an observational stepped-wedge study

Patrick M Newman et al. BMJ Glob Health. .

Abstract

Background: Non-communicable diseases (NCDs) contribute greatly to morbidity and mortality in low-income and middle-income countries (LMICs). Community health workers (CHWs) may improve disease control and medication adherence among patients with NCDs in LMICs, but data are lacking. We assessed the impact of a CHW-led intervention on disease control and adherence among patients with diabetes and/or hypertension in Chiapas, Mexico.

Methods: We conducted a prospective observational study among adult patients with diabetes and/or hypertension, in the context of a stepped-wedge roll-out of a CHW-led intervention. We measured self-reported adherence to medications, blood pressure and haemoglobin A1c at baseline and every 3 months, timed just prior to expansion of the intervention to a new community. We conducted individual-level mixed effects analyses of study data, adjusting for time and clustering by patient and community.

Findings: We analysed 108 patients. The CHW-led intervention was associated with a twofold increase in the odds of disease control (OR 2.04, 95% CI 1.15 to 3.62). It was also associated with optimal adherence assessed by 30-day recall (OR 1.86; 95% CI 1.15 to 3.02) and a positive self-assessment of adherence behaviour (OR 2.29; 95% CI 1.26 to 4.15), but not by 5-day recall.

Interpretation: A CHW-led adherence intervention was associated with disease control and adherence among adults with diabetes and/or hypertension. This study supports a role of CHWs in supplementing comprehensive primary care for patients with NCDs in LMICs.

Trial registration number: NCT02549495.

Keywords: diabetes; health systems evaluation; hypertension.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: the research was conducted in collaboration with Partners in Health who independently funded the CHW intervention, but did not fund the research; otherwise no support from any organisation for the submitted work; DP did short-term consulting work for the Samuel Family Foundation, Eleanor Crook Foundation and Sall Family Foundation.

Figures

Figure 1
Figure 1
Schematic of stepped-wedge CHW-led intervention roll-out and data collection. CHW, community health workers.
Figure 2
Figure 2
Study enrolment profile. CHW, community health workers.
Figure 3
Figure 3
Per cent disease control among the study population over time, by exposure status to community health workers-led intervention.
Figure 4
Figure 4
Per cent optimal adherence over time among the study population by 5-day, 30-day and adherence behaviour scales, by exposure status to community health workers-led intervention.
See this image and copyright information in PMC

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