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Extant literature demonstrates that a fundamental component of early Type 2 diabetes mellitus (T2DM) treatment is patient education, which in turn sets the foundation for effective treatment and management throughout the disease continuum (Robertson, 2012). It is reported in the nursing scholarship that, due to lack of effective education, many patients with diabetes are yet to realize their optimal care objectives and have difficulty following recommendations for effective self-management (Sperl-Hillen et al., 2013). In this light, the present paper aims to examine the Community Health Workers (CHW) intervention under the DREAM project (diabetes research, education, and action for minorities), and how it has been used to enhance management and control among Bangladeshi adults with T2DM in New York City.
In their seminal article on the DREAM project, Islam et al (2014) acknowledge that the CHW intervention is ideal for minority or marginalized groups that are disproportionally at an elevated threat for diabetes and have unique demographic, linguistic and socioeconomic characteristics that may impact access to and utilization of care, resulting in adverse health outcomes. In developing the evidence-based intervention to assist Bangladeshi adults with T2DM in New York City, Islam et al (2014) note that CHWs are generally indigenous to the community in which they work ethnically, linguistically, socioeconomically, and experientially providing them with a unique understanding of the norms, attitudes, values, and strengths of community members (p. 4). Consequently, the CHW intervention is informed by the urgent need to have culturally and linguistically relevant interventions for minority groups not only in the United States but also globally.
It is important to mention that the CHW model is a multi-component intervention consisting of group educational sessions done at least once per month and in a language that is understandable to diabetic patients, one-on-one visits, and phone follow-ups by professional CHWs. The educational sessions, which are guided by the Health Belief Model and Social Support Theory, cover core content areas such as nutrition, physical activity and complications of diabetes, with all materials tailored with specific cultural and religious practices in mind (Islam et al., 2014). One-on-one visits are intended to provide diabetic patients with the opportunity to discuss individualized care needs related to the management of the disease, while phone follow-ups are intended to both encourage adherence to discussed care plans, as well as to enhance retention of patients (Islam et al., 2014).
According to the research findings, the CHW intervention has the capacity to (1) decrease levels of Hemoglobin Alc (HbA1c), lipid profiles, as well as systolic and diastolic blood pressure, (2) enhance access and utilization of healthcare for Bangladeshi adults (minority population) with T2DM in New York City, (3) trigger a positive impact of knowledge and practice of physical activity and healthful eating in this group of the population, (4) increase levels of perceived social support, (5) enhance perceived benefits and lower perceived barriers, and (6) facilitate higher levels of self-efficacy (Islam et al., 2014). As postulated by these authors, clinical measures include[d] HbAlc, lipid profile (cholesterol, HDL, LDL, and triglycerides), systolic and diastolic blood pressure, height, and weight (p. 8). Reinforcing measures for CHW intervention include social support, self-efficacy, social capital and religiosity, while knowledge and health behaviors include diabetes knowledge, diabetes management, dietary practices, food behavior, tobacco use, physical activity, medication adherence and mental health (Islam et al., 2014).
The discussed intervention provides useful insights into the nursing profession and practice. The major significance of the study, it seems, is demonstrating the use of the CHW intervention with the view to showing nursing professionals and other parties in the health sector the role of patient education in the management of diabetes and how it should be utilized to disparate minority populations to achieve optimal care outcomes. It is clear that nurses should have the capacity to understand the norms, attitudes, values and strengths of diabetic patients within a particular population, as well as their ethnic background, language dynamics and socioeconomic status to be able to attain positive results in the treatment and management of diabetes. As demonstrated in the findings, patient education is critical in the treatment and management of diabetes. This view is supported by Sperl-Hillen et al (2013), who argue that conventional individual diabetes education goes a long way to enhancing patient understanding and knowledge, self-efficacy, diabetes distress, and dietary practices. These implications are consistent with the view held by Robertson (2012), which elaborates patient education that underscores the unique cultural and linguistic needs of patients as a fundamental constituent of diabetes treatment and management.
Overall, it can be concluded that the CHW intervention is an important component in the fight against T2DM given the rapid growth of minority and underrepresented populations whom nursing professionals and other healthcare providers have difficulty reaching or communicating with, hence reducing health disparities as well as bridging the cultural and social barriers between underrepresented communities and the health care system. Although the discussed research article targeted Bangladeshi (minority) adults with T2DM in New York City, it is believed that the evidence-based intervention can be employed to other minority populations with the disease to attain optimal treatment and management outcomes. Consequently, the task now is for the relevant health agencies to implement the intervention so that patients may reap the benefits as illuminated in this paper.
References
Islam, N., Riley, L., Wyatt, L., Tandon, S.D., Tanner, M., Rarnam-Mukjerji, R&Trinh-Shevrin, C. (2014). Protocol for the DREAM project (diabetes research, education, and action for minorities): A randomized trial of a community health worker intervention to improve diabetic management and control among Bangladeshi adults in NYC. BMC Public Health, 14(1), 1-18.
Robertson, C. (2012). The role of the nurse practitioner in the diagnosis and early management of type 2 diabetes. Journal of the American Academy of Nurse Practitioners, 24(2), 225-233.
Sperl-Hillen, J., Beaton, S., Fernandes, O., Von Worley, A., Vazquez-Benitez, G., Hanson, A&Spain, V. (2013). Are benefits from diabetes self-management education sustained? American Journal of Managed Care, 19(2), 104-112.
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