Improvements in physical activity and some dietary behaviors in a community health worker-led diabetes self-management intervention for adults with low incomes: results from a randomized controlled trial
Open accessAbstract
People with low incomes have a disproportionate prevalence of diabetes and its complications and experience many barriers to self-management, which community health workers (CHWs) may help address. We sought to examine the effects of an in-home CHW-led intervention for adults with diabetes and incomes <250% of the federal poverty line on self-management behaviors and test mediators and moderators. From 2010 to 2013, we randomized participants from three Washington State health systems with type 2 diabetes and hemoglobin A1c (HbA1c) ≥ 8% to the CHW intervention (N = 145) or usual care control (N = 142) arms. We examined effects on 12-month self-management: physical activity, dietary behaviors, medication taking, blood glucose monitoring, foot care, and tobacco use. For behaviors with significant intervention-control group differences, we tested mediation by self-efficacy and social support. We also investigated whether intervention-associated changes in behaviors varied by race/ethnicity, gender, and baseline values of HbA1c, diabetes distress, depression, and food insecurity (moderators). Compared to controls, intervention participants engaged in more physical activity and reported better dietary behaviors for some measures (general diet, frequency of skipping meals, and frequency of eating out) at 12-months, but there was no evidence of mediation by self-efficacy or social support. Evidence of moderation was limited: improvements in the frequency of skipping meals were restricted to participants with baseline HbA1c < 10%. Study findings suggest CHWs could be integrated into diabetes care to effectively support lifestyle changes around physical activity and some eating behaviors among adults with low incomes. More research is needed to understand mechanisms of change.
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Health behavior change strategies may be delivered by mental health professionals, DCES, other trained health care professionals, or qualified community health workers.
“Health behavior change strategies may be delivered by mental health professionals, DCES, or other trained health care professionals (307,312-314) or qualified community health workers (307,308).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [308]
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- Authors
- Gray, K. E., Hoerster, K. D., Taylor, L., Krieger, J., & Nelson, K. M.
- Affiliations
- United States Department of Veterans Affairs (US)
- University of Washington (US)
- Corresponding author
- Gray, Kristen E
- Venue
- Translational Behavioral Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-08-23
- Volume
- 11
- Issue
- 12
- Pages
- 2144-2154
- ISSN
- 1613-9860 (ISSN-L)
- 1869-6716
- PMC
- PMC8670415
- OpenAlex
- W3193553707
- Cited by
- 35
- References
- 57
- Citations by year
- 2026: 8 · 2025: 5 · 2024: 11 · 2023: 6 · 2022: 4 · 2021: 1
- FWCI
- 4.10
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- public-domain
- Locations
- Translational Behavioral Medicine (publishedVersion, public-domain)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Diabetes and Digestive and Kidney Diseases (5R18DK088072)
- US Department of Veterans Affairs Health Services Research & Development Program (TPP #61-029, CDA #16–154)
- Veterans Health Administration Diabetes Quality Enhancement Research Initiative
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Health Professions › General Health Professions › Community Health and Development
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- community health workers, diabetes self-management, type 2 diabetes, low-income adults, physical activity, dietary behavior, medication adherence, blood glucose monitoring, foot care, tobacco use, self-efficacy, social support, mediation, moderation, food insecurity, diabetes distress, depression, HbA1c
- MeSH terms
- Self-Management, Adult, Blood Glucose, Community Health Workers, Diabetes Mellitus, Type 2, Diet, Humans, Poverty, Self Care, Blood Glucose Self-Monitoring, Exercise
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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