Innovative Diabetes Management for Monolingual Spanish-Speaking Patients

Introduction: While a number of studies have noted that promotoras de salud/community health workers (CHW) are effective in improving diabetes-related knowledge food and physical activity behaviors through self-management, there is little evidence available examining the effects of bilingual student apprentices acting in a support role for CHWs on diabetes outcomes in non-student run medical clinics. In this pilot program in a non-profit family medical clinic run by providers and staffed by bilingual CHWs and student apprentices, we examined the effectiveness of CHW and student apprentices in enhancing diabetes patient care through an EMR-prompted diabetes management system. Methods: Demographic, health literacy (and medication adherence data were collected. Self-rated health and diabetes knowledge data were self-reported via questionnaire (adapted from the Diabetes Care Profile developed by the Michigan Research Center) at baseline and after 3 months. Chi-square tests were used to compare understanding at baseline and after 3 months. Results: A total of 34 primarily Mexican-born, low-income patients provided baseline data and 20 provided follow-up data. At baseline, 36% of patients had a high likelihood of low literacy and 42% had a possibility of low literacy and 17% reported low adherence. At baseline, 60% of patients reported high adherence to medications, which did not significantly change at 3-month follow-up. From baseline to 3-months- self-rated health, understanding of overall diabetes care, how lifestyle and medicines affect blood sugar levels, and prevention of long-term complications of diabetes marginally changed. Understanding the benefits of coping with stress, healthy diet for blood sugar control, how to use the results of blood sugar monitoring, prevention and treatment of high and low blood sugar levels, foot care, and improving blood sugar control significantly changed. Conclusions: Bilingual student apprentices supporting CHWs were effective in improving self- rated health and understanding of diabetes care for this primarily low literacy, Mexican-born and low-income population at a non-profit family medical clinic