Monday, April 21
Grant Miller: Managerial Incentives in Public Service Delivery
Heisler, Michele, M. Spencer, J. Forman, C. Robinson, C. Shultz, G. Palmisano, G. Graddy-Dansby, and E. Kieffer. 2009. "Participants' Assessments of the Effects of a Community Health Worker Intervention on Their Diabetes Self-Management and Interactions with Healthcare Providers." American Journal of Preventive Medicine, 37(6): S270-S279.
Background: The specific ways in which community health worker (CHW) programs affect participants' healthcare behaviors and interactions with their healthcare providers, as well as mechanisms by which CHW programs influence these outcomes, are poorly understood. A qualitative descriptive study of participants in a successful CHW diabetes self-management program was designed to examine: (1) what gaps in diabetes care, with a focus on patient-doctor interactions, participant identify; (2) how the program influences participants' diabetes care and interactions with healthcare providers, and what gaps, if any, it addresses. Methods: From November 2005 to December 2006, semi-structured interviews with 40 African-American and Latino adults were conducted and analyzed. Participants had diabetes and had completed or were active in a CHW-led diabetes self-management program developed and implemented using community-based participatory research principles in Detroit. Interviews were audio-taped, transcribed, and coded through a consensual and iterative process. Results: Participants reported that prior to the intervention they had received inadequate information from healthcare providers for effective diabetes self-management, had had low expectations for help from their providers, and had not felt comfortable asking questions or making requests of their healthcare providers. Key ways participants reported that the program improved their ability to manage their diabetes were by providing (1) clear and detailed information on diabetes and diabetes care; (2) education and training on specific strategies to meet diabetes care goals; (3) Sustained and nonjudgmental assistance to increase their motivation and confidence; and (4) social and peer support that enabled them to better manage their diabetes. The knowledge and confidence gained through the CHW intervention increased participants' assertiveness in asking questions to and requesting necessary tests and results from their providers. Conclusions: Study Findings suggest ways that CHW programs that provide both one-on-one support and group self-management training sessions may be effective in promoting more effective diabetes care and patient-doctor relationships among Latino and African-American adults with diabetes. Through these mechanisms, such interventions may help to mitigate racial and ethnic disparities in diabetes care and outcomes. (Am J Prev Med 2009;37(6S1):S270-S279) (C) 2009 Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
Country of focus: United States.