TY - JOUR
T1 - Integrating Community Health Workers into Safety-Net Primary Care for Diabetes Prevention
T2 - Qualitative Analysis of Clinicians’ Perspectives
AU - Gore, Radhika
AU - Brown, Ariel
AU - Wong, Garseng
AU - Sherman, Scott
AU - Schwartz, Mark
AU - Islam, Nadia
N1 - Funding Information:
This study received all necessary ethics approvals from the NYU School of Medicine Institutional Review Board, the VA New York Harbor Healthcare System Office of Research & Development Institutional Review Board, and the Bellevue Research Review Committee and New York City Health + Hospital’s Research Administration.
Funding Information:
We are grateful to all clinicians at Bellevue Hospital and the Manhattan VA for sharing their perspectives with us. We thank Yixin Fang for advice and assistance on statistical analysis of survey data and Thomas Gepts and Shana Johnson for contributing to data synthesis and reviewing the manuscript.
Funding Information:
This study has undergone peer-review by and is supported by the National Institutes of Health - National Institute of Diabetes and Digestive and Kidney Diseases under award number R18DK110740.
Publisher Copyright:
© 2019, Society of General Internal Medicine.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Background: Evidence shows community health workers (CHWs) can effectively deliver proven behavior-change strategies to prevent type 2 diabetes mellitus (diabetes) and enhance preventive care efforts in primary care for minority and low-income populations. However, operational details to integrate CHWs into primary care practice remain less well known. Objective: To examine clinicians’ perceptions about working with CHWs for diabetes prevention in safety-net primary care. Setting: Clinicians are primary care physicians and nurses at two New York City safety-net hospitals participating in CHORD (Community Health Outreach to Reduce Diabetes). CHORD is a cluster-randomized trial testing a CHW intervention to prevent diabetes. Design: Guided by the Consolidated Framework for Implementation Research, we studied how features of the CHW model and organizational context of the primary care practices influenced clinicians’ perspectives about the acceptability, appropriateness, and feasibility of a diabetes-prevention CHW program. Data were collected pre-intervention using semi-structured interviews (n = 18) and a 20-item survey (n = 54). Approach: Both survey and interview questions covered clinicians’ perspectives on diabetes prevention, attitudes and beliefs about CHWs’ role, expectations in working with CHWs, and use of clinic- and community-based diabetes- prevention resources. Survey responses were descriptively analyzed. Interviews were coded using a mix of deductive and inductive approaches for thematic analysis. Key Results: Eighty-seven percent of survey respondents agreed CHWs could help in preventing diabetes; 83% reported interest in working with CHWs. Ninety-one percent were aware of clinic-based prevention resources; only 11% were aware of community resources. Clinicians supported CHWs’ cultural competency and neighborhood reach, but expressed concerns about the adequacy of CHWs’ training; public and professional emphasis on diabetes treatment over prevention; and added workload and communication with CHWs. Conclusions: Clinicians found CHWs appropriate for diabetes prevention in safety-net settings. However, disseminating high-quality evidence about CHWs’ effectiveness and operations is needed to overcome concerns about integrating CHWs in primary care.
AB - Background: Evidence shows community health workers (CHWs) can effectively deliver proven behavior-change strategies to prevent type 2 diabetes mellitus (diabetes) and enhance preventive care efforts in primary care for minority and low-income populations. However, operational details to integrate CHWs into primary care practice remain less well known. Objective: To examine clinicians’ perceptions about working with CHWs for diabetes prevention in safety-net primary care. Setting: Clinicians are primary care physicians and nurses at two New York City safety-net hospitals participating in CHORD (Community Health Outreach to Reduce Diabetes). CHORD is a cluster-randomized trial testing a CHW intervention to prevent diabetes. Design: Guided by the Consolidated Framework for Implementation Research, we studied how features of the CHW model and organizational context of the primary care practices influenced clinicians’ perspectives about the acceptability, appropriateness, and feasibility of a diabetes-prevention CHW program. Data were collected pre-intervention using semi-structured interviews (n = 18) and a 20-item survey (n = 54). Approach: Both survey and interview questions covered clinicians’ perspectives on diabetes prevention, attitudes and beliefs about CHWs’ role, expectations in working with CHWs, and use of clinic- and community-based diabetes- prevention resources. Survey responses were descriptively analyzed. Interviews were coded using a mix of deductive and inductive approaches for thematic analysis. Key Results: Eighty-seven percent of survey respondents agreed CHWs could help in preventing diabetes; 83% reported interest in working with CHWs. Ninety-one percent were aware of clinic-based prevention resources; only 11% were aware of community resources. Clinicians supported CHWs’ cultural competency and neighborhood reach, but expressed concerns about the adequacy of CHWs’ training; public and professional emphasis on diabetes treatment over prevention; and added workload and communication with CHWs. Conclusions: Clinicians found CHWs appropriate for diabetes prevention in safety-net settings. However, disseminating high-quality evidence about CHWs’ effectiveness and operations is needed to overcome concerns about integrating CHWs in primary care.
KW - community health worker
KW - diabetes prevention
KW - health disparities
KW - implementation research
KW - primary care
UR - http://www.scopus.com/inward/record.url?scp=85076877352&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85076877352&partnerID=8YFLogxK
U2 - 10.1007/s11606-019-05581-8
DO - 10.1007/s11606-019-05581-8
M3 - Article
C2 - 31848857
AN - SCOPUS:85076877352
SN - 0884-8734
VL - 35
SP - 1199
EP - 1210
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 4
ER -