Clinical and behavioral effects of interventions that feature promotoras to treat type 2 diabetes in Latino adults

BACKGROUND: Type 2 diabetes disproportionately affects Latino populations. Interventions in which community health workers (CHWs) or promotoras are a part have demonstrated some success among Hispanic populations with cardiovascular disease and hypertension. However, to date there are no reviews that describe the clinical or behavioral outcomes of diabetes self-management interventions supported by promotoras. RESEARCH QUESTION: What are the behavioral and clinical effects of interventions supported by promotoras to treat type 2 diabetes in Latino adults (\u3e18 years old)? METHODS: A search of electronic databases—Pubmed, Medline, PsycInfo, CINAHL—was conducted using specified search terms. Reference lists of articles were hand searched to identify any additional articles. Data were extracted from articles by one reviewer using the ADA Evidence Abstract Worksheet (see Appendix A). This form was used to identify the study purpose, study type, setting, population, and outcomes, and to describe the main features of the intervention. Each study was assessed using the ADA Quality Criteria Checklist: Primary Research (see Appendix B). Each study was assessed on four measures of relevance and ten measures of validity and received a grade of positive, negative, or neutral. Results were compiled in an overview table, patterned after the ADA Overview Table Template (see Appendix C). RESULTS: Six of the eight studies found statistically significant reductions in glycosylated hemoglobin (HbA1c) in interventions supported by or led by promotoras. Four of the five studies investigating diabetes knowledge, found statistically significant improvements in diabetes knowledge. DISCUSSION: The results of this systematic review suggest several positive diabetes outcomes from promotoras-led or supported interventions. Furthermore, the results suggest the effectiveness and appeal of CHW supported interventions to improve HbA1c and diabetes knowledge among Hispanic, female populations. Further research is needed to investigate the link between interventions involving promotoras and improvement in behavioral and clinical outcomes of Latino populations with type 2 diabetes