Premium
Impact of a community‐based approach to patient engagement in rural, low‐income adults with type 2 diabetes
Author(s) -
Glenn Lynn E.,
Nichols Michelle,
Enriquez Maithe,
Jenkins Carolyn
Publication year - 2019
Publication title -
public health nursing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.471
H-Index - 55
eISSN - 1525-1446
pISSN - 0737-1209
DOI - 10.1111/phn.12693
Subject(s) - medicine , psychological intervention , diabetes management , diabetes mellitus , community health , type 2 diabetes , coaching , intervention (counseling) , family medicine , health care , gerontology , public health , nursing , psychology , economic growth , economics , psychotherapist , endocrinology
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.