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Randomized Controlled Trial
. 2020 Mar;37(2):178-187.
doi: 10.1111/phn.12693. Epub 2019 Dec 13.

Impact of a community-based approach to patient engagement in rural, low-income adults with type 2 diabetes

Lynn E Glenn  1 , Michelle Nichols  2 , Maithe Enriquez  1 , Carolyn Jenkins  2
Affiliations
Randomized Controlled Trial

Impact of a community-based approach to patient engagement in rural, low-income adults with type 2 diabetes

Lynn E Glenn et al. Public Health Nurs. 2020 Mar.

Abstract

Objective: This secondary analysis examined the relationships between Patient Activation Measure (PAM) scores, use of health services, and HgA1C.

Design: A feasibility study was conducted for a community-based intervention for high-risk adults with uncontrolled diabetes. Data were collected at baseline and monthly, including PAM and modified Diabetes Self-Management Assessment Report Tool.

Intervention: Participants (n = 58) were randomized to a 3-month nurse (RN) telephone management or community health worker (CHW) in-home intervention, focusing on medication adherence, timely follow-up, diabetes self-management coaching, and linkage to resources.

Results: Sample was mostly female (73%), African-American (90%), low income (75%), high school education or less (80%), and mean age of 59 years. A positive association between PAM score and self-reported diabetes care recommendations was found (r = .356, p = .014) and significant correlation between baseline PAM score and HgA1C levels (r = -.306, p = .029). A paired samples t test showed statistically significant increases in PAM scores in the CHW intervention group (mean increase +8.5, CI [+2.49 to +14.65]); baseline (M = 60.31, SD = 13.3) to end of study ([M = 68.89, SD = 16.39], t(22) = 2.924, p = .008 [two-tailed]).

Conclusion: A community-based approach to diabetes management demonstrated a positive effect on patient activation. Although disparities in health care access among rural, low-income populations exist, community-based interventions show potential for improving patient engagement in diabetes management and recommended health services.

Keywords: community health worker; diabetes mellitus type 2; health promotion; patient activation; patient activation measure; patient engagement; poverty; rural population; self-management.

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Figures

Figure 1:
Figure 1:
Conceptual Model - Levels of Patient Activation (PAM). Copyright 2018 by Insignia. Reprinted with permission.
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