Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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

References

    1. UN. Political declaration of the high-level meeting of the general assembly on the prevention and control of non-communicable diseases. http://www.who.int/nmh/events/un_ncd_summit2011/political_declaration_en... (accessed 19 Apr 2017).
    1. WHO. Global status report on noncommunicable diseases. 2010. http://www.who.int/nmh/publications/ncd_report2010/en/ (accessed April 19, 2017).
    1. Di Cesare M, Khang YH, Asaria P, et al. Inequalities in non-communicable diseases and effective responses. Lancet 2013;381:585–97. 10.1016/S0140-6736(12)61851-0 - DOI - PubMed
    1. Secretaría de Salud, México. Estragedia nacional para la prevención y el control del sobrepeso, la obesidad y la diabetes. http://promocion.salud.gob.mx/dgps/descargas1/estrategia/Estrategia_con_... (accessed 19 Apr 2017).
    1. Secretaría de Salud, México. Programa de acción específico: prevención y control de la obesidad y riesgo cardiovascular 2013-2018. http://www.cenaprece.salud.gob.mx/descargas/pdf/PAE_PrevencionControlObe... (accessed April 19, 2017).

Associated data

LinkOut - more resources