Examine effectiveness of CHWs in supporting a nurse-led DSME intervention among clients who are characterized by high rates of poverty and poor education.


Study Population/Research Design: New Kentucky Homeplace clients (3,217) ages 18-65+ from a 26-county study area who were processed prior to study starting date July 1, 2011. The 30.6% (983) of clients who had been told by a health professional they were diabetic, could speak English, and were willing to sign IRB consent were eligible to participate. Women who were diagnosed with diabetes during pregnancy were not eligible. Clients were able to enroll on a first-come basis up to a cutoff of the sample size of 495, with approximately 20 from each county to maintain geographic representation. After dropouts and disqualification for failure to keep appointments, 215 clients completed a single-group pretest and posttest design.

Demographic and background variables included age, gender, marital status, education, income, federal poverty level, health insurance status, visit to diabetes educator, and New Vital Sign (NVS) test of health literacy level.

Pretest and posttest measures included A1C , Weight (pounds), Height (ft., in.), Diabetes Knowledge Test (DKT), Diabetes Empowerment Scale – Short Form (DES - SF), and the Summary of Diabetes Self-care Activities (SDSCA) Measure.

Demographic and background data were collected by CHWs, and they administered the NVS, DKT, DES - SF, and SDSCA tests. The nurse educator administered measures of weight, height, and A1C.

Key Findings

Study group was predominantly female (65.7%), poorly educated (29.8% < high school), 45.6% in poverty, 58.1% without health insurance, 68.8% never visited a diabetes educator, and 44.7% with the possibility of limited health literacy. Glucose testing improved and A1C lowered in post testing after DSME intervention.


CHWs were effective in providing support for DSME. They succeeded in screening clients, obtaining their IRB consent, and enrolling them in the study. They successfully administered study instruments, provided follow-up assistance to clients regarding the DSME and entered data into the Homeplace database. CHWs can play a key role in DSME in areas where there is a shortage of primary care physicians and CDEs.

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Notes/Citation Information

A poster presentation at the National Rural Health Association’s 36th Annual Rural Health Conference in Louisville, KY.

Funding Information 

I DO Phase I was supported by a $150,000 gift from the Anthem Foundation, and I DO Phase II is made possible by an additional gift of $150,000 from the Anthem Foundation.