• J Gen Intern Med · Feb 2024

    Implementation and Evaluation of a mHealth-Based Community Health Worker Feedback Loop for Hispanics with and at Risk for Diabetes.

    • Elizabeth M Vaughan, Victor J Cardenas, Wenyaw Chan, Amber B Amspoker, Craig A Johnston, Salim S Virani, Christie M Ballantyne, and Aanand D Naik.
    • Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX, USA. emvaugha@utmb.edu.
    • J Gen Intern Med. 2024 Feb 1; 39 (2): 229238229-238.

    BackgroundGaps in accessibility and communication hinder diabetes care in poor communities. Combining mobile health (mHealth) and community health workers (CHWs) into models to bridge these gaps has great potential but needs evaluation.ObjectiveTo evaluate a mHealth-based, Participant-CHW-Clinician feedback loop in a real-world setting.DesignQuasi-experimental feasibility study with intervention and usual care (UC) groups.ParticipantsA total of 134 participants (n = 67/group) who were all low-income, uninsured Hispanics with or at-risk for type 2 diabetes.InterventionA 15-month study with a weekly to semimonthly mHealth Participant-CHW-Clinician feedback loop to identify participant issues and provide participants monthly diabetes education via YouTube.Main MeasuresWe used pre-defined feasibility measures to evaluate our intervention: (a) implementation, the execution of feedback loops to identify and resolve participant issues, and (b) efficacy, intended effects of the program on clinical outcomes (baseline to 15-month HbA1c, systolic blood pressure (SBP), diastolic blood pressure (DBP), and weight changes) for each group and their subgroups (at-risk; with diabetes, including uncontrolled (HbA1c ≥ 7%)).Key ResultsCHWs identified 433 participant issues (mean = 6.5 ± 5.3) and resolved 91.9% of these. Most issues were related to supplies, 26.3% (n = 114); physical health, 23.1% (n = 100); and medication access, 20.8% (n = 90). Intervention participants significantly improved HbA1c (- 0.51%, p = 0.03); UC did not (- 0.10%, p = 0.76). UC DBP worsened (1.91 mmHg, p < 0.01). Subgroup analyses revealed HbA1c improvements for uncontrolled diabetes (intervention: - 1.59%, p < 0.01; controlled: - 0.72, p = 0.03). Several variables for UC at-risk participants worsened: HbA1c (0.25%, p < 0.01), SBP (4.05 mmHg, p < 0.01), DBP (3.21 mmHg, p = 0.01). There were no other significant changes for either group.ConclusionsA novel mHealth-based, Participant-CHW-Clinician feedback loop was associated with improved HbA1c levels and identification and resolution of participant issues. UC individuals had several areas of clinical deterioration, particularly those at-risk for diabetes, which is concerning for progression to diabetes and disease-related complications.Clinical TrialNCT03394456, accessed at https://clinicaltrials.gov/ct2/show/NCT03394456.© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.

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