title: A Randomized Community-based Intervention Trial Comparing Faith Community Nurse Referrals to Telephone-Assisted Physician Appointments for Health Fair Participants with Elevated Blood Pressure EMPOWER: a randomized trial using community health workers to deliver a lifestyle intervention program in African American women with Type 2 diabetes: design, rationale, and baseline characteristics. Randomized Controlled Trial of a Community Health Worker Self-Management Support Intervention Among Low-Income Adults With Diabetes, Seattle, Washington, 2010–2014 The effects of a nurse case manager and a community health worker team on diabetic control, emergency department visits, and hospitalizations among urban African Americans with type 2 diabetes mellitus: a randomized controlled trial. Comparing Interventions in Older Unpartnered Adults after Myocardial Infarction Results of the Northern Manhattan Diabetes Community Outreach Project: A Randomized Trial Studying a Community Health Worker Intervention to Improve Diabetes Care in Hispanic Adults Comparative Effectiveness of Peer Leaders and Community Health Workers in Diabetes Self-management Support: Results of a Randomized Controlled Trial Building skill in heart failure self-care among community dwelling older adults: results of a pilot study. Health Coaching to Improve Hypertension Treatment in a Low-Income, Minority Population Underserved urban african american men: hypertension trial outcomes and mortality during 5 years. Health effectiveness of community health workers as a diabetes self-management intervention Improvement of rural children's asthma self-management by lay health educators. Cognitive Behavioral Therapy for Insomnia in Older Veterans Using Nonclinician Sleep Coaches: Randomized Controlled Trial. Mexican American trial of community health workers: a randomized controlled trial of a community health worker intervention for Mexican Americans with type 2 diabetes mellitus. Community Health Workers Versus Nurses as Counselors or Case Managers in a Self-Help Diabetes Management Program. Impact of Distress Reduction on Behavioral Correlates and A1C in African American Women with Uncontrolled Type 2 Diabetes: Results from EMPOWER. Results from a community-based trial testing a community health worker asthma intervention in Puerto Rican youth in Chicago A Community Health Worker-Delivered Intervention in African American Women with Type 2 Diabetes: A 12-Month Randomized Trial. Defining and measuring health equity effects in research on task shifting interventions in high-income countries: a systematic review protocol
abstract: OBJECTIVE To measure the effect of faith community nurse referrals versus telephone-assisted physician appointments on blood pressure control among persons with elevated blood pressure at health fairs . METHODS R and omized community-based intervention trial conducted from October 2006 to October 2007 of 100 adults who had an average blood pressure reading equal to or above a systolic of 140 mm Hg or a diastolic of 90 mm Hg obtained at a faith community nurse-led church health event . Participants were r and omized to either referral to a faith community nurse or to a telephone-assisted physician appointment .  The average enrollment systolic blood pressure ( SBP ) was 149 ± 14 mm Hg , diastolic blood pressure ( DBP ) was 87 ± 11 mm Hg , 57 % were uninsured and 25 % were undiagnosed at the time of enrollment . RESULTS The follow-up rate was 85 % at 4 months . Patients in the faith community nurse referral arm had a 7 ± 15 mm Hg drop in SBP versus a 14 ± 15 mm Hg drop in the telephone-assisted physician appointment arm ( p = 0.04 ) . Twenty-seven percent of the patients in the faith community nurse referral arm had medication intensification compared to 32 % in the telephone-assisted physician appointment arm ( p = 0.98 ) . CONCLUSIONS Church health fairs conducted in low-income , multiethnic communities can identify many people with elevated blood pressure . Facilitating physician appointments for people with elevated blood pressure identified at health fairs confers a greater decrease in SBP than referral to a faith community nurse at four months BACKGROUND African American ( AA ) women with Type 2 diabetes mellitus ( T2DM ) in the rural south experience less weight loss and poorer glycemic control in traditional diabetes management programs compared to Caucasians . This paper describes the design , rationale , and baseline characteristics from an innovative community health worker ( CHW ) delivered intervention program in this population . METHODS / DESIGN This prospect i ve trial r and omized rural AA women with uncontrolled T2DM ( HbA1c ≥ 7.0 ) to receive a behaviorally-centered , culturally-tailored lifestyle intervention during 16 contacts  from a trained AA CHW or 16 approved diabetes educational mailings . Changes from baseline in glycosylated hemoglobin levels ( HbA1c ) , blood pressure ( BP ) , weight , body mass index ( BMI ) , self-reported dietary and physical activity patterns , and psychosocial measures including diabetes distress , empowerment , depression , self-care , medication adherence , and life satisfaction will be assessed at 6- and 12-months . BASELINE RESULTS Two hundred AA women ( mean age = 53.09 ± 10.89 years ) with T2DM from impoverished rural communities were enrolled . Baseline data demonstrated profoundly uncontrolled diabetes of long term duration ( mean HbA1c = 9.11 ± 1.82 ; mean BMI = 37.68 ± 8.20 ; mean BP = 134.51 ± 20.39/84.19 ± 11.68 ; 10.5 ± 0.7 years ) . Self-care behavior assessment revealed poor dietary and medication adherence and sedentary lifestyle . Most psychosocial measures ranged within normal limits . CONCLUSION The present sample of AA women from impoverished rural communities exhibited significantly uncontrolled T2DM of long duration with associated obesity and poor lifestyle behaviors . An innovative CHW led lifestyle intervention may lead to more effective strategies for T2DM management in this population Introduction Community health workers ( CHWs ) can improve diabetes outcomes ; however , questions remain about translating research findings into practical low-intensity models for safety-net providers . We tested the effectiveness of a home-based low-intensity CHW intervention for improving health outcomes among low-income adults with diabetes . Methods Low-income patients with glycated hemoglobin A1c ( HbA1c ) of 8.0 % or higher in the 12 months before enrollment from 3 safety-net providers were r and omized to a 12-month CHW-delivered diabetes self-management intervention or usual care . CHWs were based at a local health department . The primary outcome was change in HbA1c from baseline enrollment to 12 months ; secondary outcomes included blood pressure and lipid levels , quality of life , and health care use . Results The change in HbA1c in the intervention group ( n = 145 ) ( unadjusted mean of 9.09 % to 8.58 % , change of −0.51 ) compared with the control group ( n = 142 ) ( 9.04 % to 8.71 % , change of −0.33 ) was not significant ( P = .54 ) . In an analysis of participants with poor glycemic control ( HbA1c > 10 % ) , the intervention group had a 1.23-point greater decrease in HbA1c compared with controls ( P = .046 ) . For the entire study population , we found a decrease in reported physician visits ( P < .001 ) and no improvement in health-related quality of life ( P = .07 ) in the intervention group compared with the control group . Conclusion A low-intensity CHW-delivered intervention to support diabetes self-management did not significantly improve HbA1c relative to usual care . Among the subgroup of participants with poor glycemic control ( HbA1c > 10 % at baseline ) , the intervention was effective BACKGROUND Although African American adults bear a disproportionate burden from diabetes mellitus ( DM ) , few r and omized controlled trials have tested culturally appropriate interventions to improve DM care . METHODS We r and omly assigned 542 African Americans with type 2 DM enrolled in an urban managed care organization to either an intensive or minimal intervention group . The intensive intervention group consisted of all components of the minimal intervention plus individualized , culturally tailored care provided by a nurse case manager ( NCM ) and a community health worker ( CHW ) , using evidence -based clinical algorithms with feedback to primary care providers ( eg , physicians , nurse practitioners , or physician assistants ) . The minimal intervention consisted of mailings and telephone calls every 6 months to remind participants about preventive screenings . Data on diabetic control were collected at baseline and at 24 months by blind observers ; data emergency department ( ER ) visits and hospitalizations were assessed using administrative data . RESULTS At baseline , participants had a mean age of 58 years , 73 % were women , and 50 % were living in poverty . At 24 months , compared with the minimal intervention group , those in the intensive intervention group were 23 % less likely to have ER visits ( rate difference [ RD ] , -14.5 ; adjusted rate ratio [ RR ] , 0.77 ; 95 % confidence interval [ CI ] , 0.59 - 1.00 ) . In on-treatment analyses , the rate reduction was strongest for patients who received the most NCM and CHW visits ( RD , -31.0 ; adjusted RR , 0.66 ; 95 % CI , 0.43 - 1.00 ; rate reduction downward arrow 34 % ) . CONCLUSION These data suggest that a culturally tailored intervention conducted by an NCM/CHW team reduced ER visits in urban African Americans with type 2 DM . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00022750 Background : Older adults after myocardial infa rct ion ( MI ) are a vulnerable group who may benefit from interventions to improve health outcomes . The use of a peer advisor or an advanced practice nurse ( APN ) to provide a self-efficacy intervention is a promising method of improving health outcomes after MI . Aims : The purpose of this paper was to compare the effect of two self-efficacy interventions , a peer advisor and an APN , to a group who received st and ard care after MI . Methods : The study was a three-group r and omized clinical trial with a peer advisor intervention group , an APN intervention group , and a st and ard care group . Outcome data were collected in the hospital after MI and by telephone at 12 weeks after hospital discharge , after the interventions were completed . Results : At 12 weeks after MI , there were no significant differences between the 3 groups in health outcomes . There were similar changes in self-efficacy for performing recovery behaviors , the actual performance of recovery behavior , physical and mental health across both intervention groups and the st and ard care group . Conclusions : Although the data did not vali date the benefits of these self-efficacy interventions , future efforts at identifying changes in health outcomes may need to use more discrete measurements that are more sensitive to changes in the older unpartnered adult after an MI OBJECTIVE The Northern Manhattan Diabetes Community Outreach Project evaluated whether a community health worker ( CHW ) intervention improved clinical ly relevant markers of diabetes care in adult Hispanics . RESEARCH DESIGN AND METHODS Participants were adult Hispanics , ages 35–70 years , with recent hemoglobin A1c ( A1C ) ≥8 % ( ≥64 mmol/mol ) , from a university-affiliated network of primary care practice s in northern Manhattan ( New York City , NY ) . They were r and omized to a 12-month CHW intervention ( n = 181 ) , or enhanced usual care ( educational material s mailed at 4-month intervals , preceded by phone calls , n = 179 ) . The primary outcome was A1C at 12 months ; the secondary outcomes were systolic blood pressure ( SBP ) , diastolic blood pressure , and LDL-cholesterol levels . RESULTS There was a nonsignificant trend toward improvement in A1C levels in the intervention group ( from unadjusted mean A1C of 8.77 to 8.40 % ) , as compared with usual care ( from 8.58 to 8.53 % ) ( P = 0.131 ) . There was also a nonsignificant trend toward an increase in SBP and LDL cholesterol in the intervention arm . Intervention fidelity , measured as the number of contacts in the intervention arm ( visits , phone contacts , group support , and nutritional education ) , showed a borderline association with greater A1C reduction ( P = 0.054 ) . When assessed separately , phone contacts were associated with greater A1C reduction ( P = 0.04 ) . CONCLUSIONS The trend toward A1C reduction with the CHW intervention failed to achieve statistical significance . Greater intervention fidelity may achieve better glycemic control , and more accessible treatment models , such as phone-based interventions , may be more efficacious in socioeconomically disadvantaged population OBJECTIVE To compare a peer leader ( PL ) versus a community health worker ( CHW ) telephone outreach intervention in sustaining improvements in HbA1c over 12 months after a 6-month diabetes self-management education ( DSME ) program . RESEARCH DESIGN AND METHODS One hundred and sixteen Latino adults with type 2 diabetes were recruited from a federally qualified health center and r and omized to 1 ) a 6-month DSME program followed by 12 months of weekly group sessions delivered by PLs with telephone outreach to those unable to attend or 2 ) a 6-month DSME program followed by 12 months of monthly telephone outreach delivered by CHWs . The primary outcome was HbA1c . Secondary outcomes were cardiovascular disease risk factors , diabetes distress , and diabetes social support . Assessment s were conducted at baseline , 6 , 12 , and 18 months . RESULTS After DSME , the PL group achieved a reduction in mean HbA1c ( 8.2–7.5 % or 66–58 mmol/mol , P < 0.0001 ) that was maintained at 18 months ( −0.6 % or −6.6 mmol/mol from baseline [ P = 0.009 ] ) . The CHW group also showed a reduction in HbA1c ( 7.8 vs. 7.3 % or 62 vs. 56 mmol/mol , P = 0.0004 ) post–6 month DSME ; however , it was attenuated at 18 months ( −0.3 % or −3.3 mmol/mol from baseline , within-group P = 0.234 ) . Only the PL group maintained improvements achieved in blood pressure at 18 months . At the 18-month follow-up , both groups maintained improvements in waist circumference , diabetes support , and diabetes distress , with no significant differences between groups . CONCLUSIONS Both low-cost maintenance programs led by either a PL or a CHW maintained improvements in key patient-reported diabetes outcomes , but the PL intervention may have additional benefit in sustaining clinical improvements beyond 12 months OBJECTIVE Most of the day-to-day care for heart failure ( HF ) is done by the patient at home and requires skill in self-care . In this r and omized controlled trial ( RCT ) we tested the efficacy of a community-based skill-building intervention on HF self-care , knowledge and health-related quality of life ( HRQL ) at 1- and 3-months . METHODS An ethnically diverse sample ( n=75 ) of patients with HF ( 53 % female ; 32 % Hispanic , 27 % Black ; mean age 69.9±10 years ) was r and omized to the intervention group ( IG ) or a wait-list control group ( CG ) . The protocol intervention focused on tactical and situational HF self-care skill development delivered by lay health educators in community senior centers . Data were analyzed using mixed ( between-within subjects ) ANOVA . RESULTS There was a significant improvement in self-care maintenance [ F(2,47)=3.42 , p=.04 , ( Cohen 's f=.38 ) ] , self-care management [ F(2,41)=4.10 , p=.02 , ( Cohen 's f=.45 ) and HF knowledge [ F(2,53)=8.00 , p=.001 ( Cohen 's f=.54 ) ] in the IG compared to the CG . CONCLUSIONS The skill-building intervention improved self-care and knowledge but not HRQL in this community-dwelling sample . PRACTICE IMPLICATION S Delivering an intervention in a community setting using lay health educators provides an alternative to clinic- or home-based teaching that may be useful across diverse population s and geographically varied setting PURPOSE Poor blood pressure control is common in the United States . We conducted a study to determine whether health coaching with home titration of antihypertensive medications can improve blood pressure control compared with health coaching alone in a low-income , predominantly minority population . METHODS We r and omized 237 patients with poorly controlled hypertension at a primary care clinic to receive either home blood pressure monitoring , weekly health coaching , and home titration of blood pressure medications if blood pressures were elevated ( n = 129 ) vs home blood pressure monitoring and health coaching but no home titration ( n = 108 ) . The primary outcome was change in systolic blood pressure from baseline to 6 months . RESULTS Both the home-titration arm and the no – home-titration arm had a reduction in systolic blood pressure , with no significant difference between them . When both arms were combined and analyzed as a before-after study , there was a mean decrease in systolic blood pressure of 21.8 mm Hg ( P < .001 ) as well as a decrease in the number of primary care visits from 3.5 in the 6 months before the study to 2.6 during the 6-month study period ( P < .001 ) and 2.4 in the 6 months after the study ( P < .001 ) . The more coaching encounters patients had , the greater their reduction in blood pressure . CONCLUSIONS Blood pressure control in a low-income , minority population can be improved by teaching patients to monitor their blood pressure at home and having nonprofessional health coaches assist patients , in particular , by counseling them on medication adherence . The improved blood pressure control can be achieved while reducing the time spent by physicians BACKGROUND African American men with hypertension ( HTN ) in low socioeconomic urban environments continue to achieve poor rates of HTN control . METHODS In a 5-year r and omized clinical trial with 309 hypertensive urban African American men aged 21 to 54 years , the effectiveness of a more intensive educational/behavioral/pharmacologic intervention provided by a nurse practitioner/community health worker/physician team was compared to less intensive information and referral intervention . Changes in behavioral factors , health care utilization , blood pressure ( BP ) control , left ventricular hypertrophy ( LVH ) , and renal insufficiency were evaluated . RESULTS Follow-up rates exceeded 89 % of available men . The ranges of mean annual systolic BP/diastolic BP change from the baseline to each year follow-up were -3.7 to -10.1/-4.9 to -12.3 mm Hg for the more intensive group and + 3.4 to -3.0/-1.8 to -8.7 mm Hg for the less intensive group . The annual proportion of men with controlled BP ( < 140/90 mm Hg ) ranged from 17 % to 44 % in the more intensive group and 21 % to 36 % in the less intensive group . At 5 years the more intensive group had less LVH than the less intensive group and 17 % of the men were deceased primarily due to narcotic or alcohol intoxication ( 36 % ) and cardiovascular causes ( 19 % ) . CONCLUSIONS An appropriate educational/behavioral intervention significantly improved BP control and reduced some sequelae of HTN in a young African American male population . Improvement in risk factors other than HTN was limited and sustained control of HTN was difficult to maintain during 5 years Objective : To evaluate the health effectiveness of community health workers among three groups ( intervention , attentional control and control groups ) of Hispanic adults with uncontrolled ( HbA1c > 8 % ) type 2 diabetes mellitus . Methods : This was a r and omized clinical trial involving 180 English- and Spanish-speaking Hispanic individuals with uncontrolled type 2 diabetes mellitus , 40–74 years of age , who received diabetes care at an outpatient , public , urban hospital . Repeated- measures analysis of variance was used to evaluate the effect of time and group on the primary outcome measure and secondary outcomes . Group differences in the percentage of participants achieving at least 1 % reduction in HbA1c levels were assessed using chi-square tests . Results : Patients ’ ages ranged from 44 to 74 years , 40 % were male , 97 % preferred Spanish and seven Spanish-speaking countries were identified as country of origin . Relative to the control and attentional control groups , the intervention group showed greater HbA1c reduction from baseline to 12 months and was the group with the highest percentage of participants showing 1 % or more HbA1c reduction . Conclusion : Integration of community health workers improved disease control for patients with type 2 diabetes mellitus during the intervention phase . Peer-driven/interactive ways to sustain diabetes control need to be explored BACKGROUND The purpose of the present analysis is to examine changes in rural children 's  asthma self-management after they received lay health educator (LHE)-delivered classes . METHODS Elementary schools were r and omly assigned to the treatment or attention-control condition and their participating students received either asthma education or general health promotion education , respectively . The triethnic sample was composed of 183 children ( 46 % Hispanic , 29.5 % non-Hispanic white , 22 % African American , and 2.6 % other categories ) who had a mean age of 8.78 years ( SD = 1.24 ) . The time frame from baseline to postintervention was 12 weeks . RESULTS Repeated measures analysis of variance found main effects in changes in scores for children 's asthma knowledge , asthma self-management , self-efficacy for managing asthma symptoms , and metered dose inhaler ( MDI ) technique and significant group interaction effects for the treatment intervention on the measures of children 's asthma knowledge , asthma self-management , and MDI technique . CONCLUSIONS The delivery of an asthma health education intervention by trained LHEs to school-aged children was an effective means for improving children 's  knowledge and skills in asthma self-management OBJECTIVES To test a new cognitive behavioral therapy for insomnia ( CBT-I ) program design ed for use by nonclinicians . DESIGN R and omized controlled trial . SETTING Department of Veterans Affairs healthcare system . PARTICIPANTS Community-dwelling veterans aged 60 and older who met diagnostic criteria for insomnia of 3 months duration or longer ( N = 159 ) . INTERVENTION Nonclinician " sleep coaches " delivered a five-session manual-based CBT-I program including stimulus control , sleep restriction , sleep hygiene , and cognitive therapy ( individually or in small groups ) , with weekly telephone behavioral sleep medicine supervision . Controls received five sessions of general sleep education . MEASUREMENTS Primary outcomes , including self-reported ( 7-day sleep diary ) sleep onset latency ( SOL-D ) , wake after sleep onset ( WASO-D ) , total wake time ( TWT-D ) , and sleep efficiency ( SE-D ) ; Pittsburgh Sleep Quality Index ( PSQI ) ; and objective sleep efficiency ( 7-day wrist actigraphy , SE-A ) were measured at baseline , at the posttreatment assessment , and at 6- and 12-month follow-up . Additional measures included the Insomnia Severity Index ( ISI ) , depressive symptoms ( Patient Health Question naire-9 ( PHQ-9 ) ) , and quality of life ( Medical Outcomes Study 12-item Short-form Survey version 2 ( SF-12v2 ) ) . RESULTS Intervention subjects had greater improvement than controls between the baseline and posttreatment assessment s , the baseline and 6-month assessment s , and the baseline and 12-month assessment s in SOL-D ( -23.4 , -15.8 , and -17.3 minutes , respectively ) , TWT-D ( -68.4 , -37.0 , and -30.9 minutes , respectively ) , SE-D ( 10.5 % , 6.7 % , and 5.4 % , respectively ) , PSQI ( -3.4 , -2.4 , and -2.1 in total score , respectively ) , and ISI ( -4.5 , -3.9 , and -2.8 in total score , respectively ) ( all P < .05 ) . There were no significant differences in SE-A , PHQ-9 , or SF-12v2 . CONCLUSION Manual-based CBT-I delivered by nonclinician sleep coaches improves sleep in older adults with chronic insomnia OBJECTIVES We assessed whether community health workers ( CHWs ) could improve glycemic control among Mexican Americans with diabetes . METHODS We recruited 144 Mexican Americans with type 2 diabetes between January 2006 and September 2008 into the single-blinded , r and omized controlled Mexican American Trial of Community Health Workers ( MATCH ) and followed them for 2 years . Participants were assigned to either a CHW intervention , delivering self-management training through 36 home visits over 2 years , or a bilingual control newsletter delivering the same information on the same schedule . RESULTS Intervention participants showed significantly lower hemoglobin A1c levels than control participants at both year 1 Δ = -0.55 ; P = .021 ) and year 2 ( Δ = -0.69 ; P = .005 ) . We observed no effect on blood pressure control , glucose self-monitoring , or adherence to medications or diet . Intervention participants increased physical activity from a mean of 1.63 days per week at baseline to 2.64 days per week after 2 years . CONCLUSIONS A self-management intervention delivered by CHWs result ed in sustained improvements in glycemic control over 2 years among Mexican Americans with diabetes . MATCH adds to the growing body of evidence supporting the use of CHWs to reduce diabetes-related health disparities OBJECTIVES To confirm the effectiveness of community health workers ' involvement as counselors or case managers in a self-help diabetes management program in 2009 to 2014 . METHODS Our open-label , r and omized controlled trial determined the effectiveness of a self-help intervention among Korean Americans aged 35 to 80 years in the Baltimore-Washington metropolitan area with uncontrolled type 2 diabetes . We measured and analyzed physiological and psychobehavioral health outcomes of the  community health worker-counseled ( n = 54 ) and registered nurse (RN)-counseled ( n = 51 ) intervention groups in comparison with the control group ( n = 104 ) . RESULTS The community health workers ' performance was comparable to that of the RNs for both psychobehavioral outcomes ( e.g. , self-efficacy , quality of life ) and physiological outcomes . The community health worker-counseled group showed hemoglobin A1C reductions from baseline ( -1.2 % , -1.5 % , -1.3 % , and -1.6 % , at months 3 , 6 , 9 , and 12 , respectively ) , all of which were greater than reductions in the RN-counseled ( -0.7 % , -0.9 % , -0.9 % , and -1.0 % ) or the control ( -0.5 % , -0.5 % , -0.6 % , and -0.7 % ) groups . CONCLUSIONS Community health workers performed as well as or better than nurses as counselors or case managers in a self-help diabetes management program in a Korean American community OBJECTIVE Symptoms of emotional distress related to diabetes have been associated with inadequate self-care behaviors , medication non-adherence , and poor glycemic control that may predispose patients to premature death . African American women , in whom diabetes is more common and social support is often insufficient , may be at particularly high risk . The objective of this study was to examine the impact of lowering diabetes-related emotional distress on glycemic control and associated behavioral correlates in rural African American women with uncontrolled type 2 diabetes ( T2D ) . DESIGN Post-hoc analysis of prospect i ve , r and omized , controlled trial . SETTING Rural communities in the southeastern United States . PATIENTS 129 rural middle-aged African American women with uncontrolled type 2 diabetes (T2D)(A1C ≥ 7.0 ) . PRIMARY INDEPENDENT VARIABLE Diabetes-related distress . MAIN OUTCOME MEASURES Changes from baseline to 12-month follow-up in diabetes-related distress , and associated changes in medication adherence , self-care activities , self-efficacy , and glycemic control ( A1C ) . RESULTS Patients with a reduction in diabetes-related distress ( n=79 ) had significantly greater improvement in A1C , medication adherence , self-care activities , and self-efficacy compared with those in whom diabetes distress worsened or was unchanged ( n=50 ) . Changes in distress were also significantly and inversely correlated with improvements in medication adherence , self-care activities , and self-efficacy . CONCLUSIONS Among rural African American women , reductions in diabetes-related distress may be associated with lower A1C and improvements in self-efficacy , self-care behaviors , and medication adherence Abstract Objective : Puerto Rican children suffer disproportionately from asthma . Project CURA tested the efficacy of a community health worker ( CHW ) intervention to improve use of inhaled corticosteroids ( ICS ) and reduce home asthma triggers in Puerto Rican youth in Chicago . Methods : This study employed a behavioral r and omized controlled trial design with a community-based participatory research approach . Medications and technique were visually assessed ; adherence was determined using dose counters . Home triggers were assessed via self-report , visual inspection and salivary cotinine . All participants received education on core asthma topics and self-management skills . Participants in the CHW arm were offered home education by the CHW in four visits over four months . The attention control arm received four newsletters covering the same topics . Results : While most of the participants had uncontrolled persistent asthma , < 50 % had ICS at baseline . In the CHW arms , 67 % of participants received the full four-visit intervention . In the Elementary school cohort ( n = 51 ) , the CHW arm had lower odds of having an ICS ( OR = 0.2 ; p = 0.02 ) at 12-months ; no differences were seen in other outcomes between arms at any time point . The only significant treatment arm difference in the high school cohort ( n = 50 ) was in inhaler technique where the CHW arm performed 18.0 % more steps correct at five months ( p < 0.01 ) and 14.2 % more steps correct at 12 months ( p < 0.01 ) . Conclusions : While this CHW intervention did not increase the number of participants with ICS or reduce home asthma triggers , important lessons were learned including challenges to CHW intervention fidelity and the need for CHWs to partner with clinical providers OBJECTIVE To evaluate the effectiveness of a community health worker (CHW)-delivered lifestyle intervention for African American women with type 2 diabetes . METHODS Participants were r and omized to either 16 phone-based lifestyle intervention sessions aim ed at making small changes in their diet and activity or 16 educational mailings sent across 12 months . Main outcomes included glycosylated hemoglobin ( HbA1c ) , blood pressure ( BP ) , and weight ( kg ) changes . RESULTS Two hundred middle-aged ( mean = 53 ± 10.24 years ) , rural , African American women with moderate obesity ( mean BMI = 37.7 ± 8.02 ) and type 2 diabetes ( mean HbA1c = 9.1 ± 1.83 ) were enrolled . At 12 months , the intervention group exhibited no significant differences in HbA1c ( -0.29 ± 1.84 vs. + 0.005 ± 1.61 ; P = 0.789 ) or BP ( -1.01 ± 20.46/+0.66 ± 13.24 vs. + 0.22 ± 25.33/-2.87 ± 1.52 ; P = 0.100 ) but did exhibit greater weight loss ( -1.35 ± 6.22 vs. -0.39 ± 4.57 kg , respectively ; P = 0.046 ) compared with controls . Exploratory post hoc analyses revealed that participants not using insulin had significantly greater reductions in HbA1c ( -0.70 ± 1.86 vs. + 0.07 ± 2.01 ; P = 0.000 ) , diastolic BP ( -5.17 ± 14.16 vs. -3.40 ± 14.72 mmHg ; P = 0.035 ) , and weight ( -2.36 ± 6.59 vs. -1.64 ± 4.36 kg ; P = 0.003 ) compared to controls not on insulin . CONCLUSIONS A phone-based CHW intervention result ed in no significant improvements in HbA1c or BP but did demonstrate modest improvements in weight . Women not using insulin showed significant improvements in all primary outcomes Introduction Task shifting interventions are intended to both deliver clinical ly effective treatments to reduce disease burden and address health inequities or population vulnerability . Little is known about how health equity and population vulnerability are defined and measured in research focused on task shifting . This systematic review will address the following questions : Among  task shifting interventions in high-income setting s that have been studied using r and omised controlled trials or variants , how are health inequity or population vulnerability identified and defined ? What methods and indicators are used to describe , characterise and measure the population ’s baseline status and the intervention ’s impacts on inequity and vulnerability ? Methods and analysis Studies were identified through data base search es ( MEDLINE , Embase , CINAHL , PsycINFO and Web of Science ) . Eligible studies will be r and omised controlled trials published since 2004 , conducted in high-income countries , concerning task shifting interventions to treat any disease , in any population that may face health disadvantage as defined by the PROGRESS-Plus framework ( place of residence , race/ethnicity/culture/ language , occupation , gender/sex , religion , social capital , socioeconomic position , age , disability , sexual orientation , other vulnerable groups ) . We will conduct independent and duplicate title and abstract screening , then identify related papers from the same programme of research through further data base and manual search ing . From each programme of research , we will extract study details , and definitions and measures of health equity or population vulnerability based on the PROGRESS-Plus framework . Two investigators will assess the quality of reporting and measurement related to health equity and vulnerability using a scale developed for this study . A narrative synthesis will highlight similarities and differences between the gathered studies and offer critical analyses and implication s. Ethics and dissemination This review does not involve primary data collection , does not constitute research on human subjects and is not subject to additional institutional ethics review or informed consent procedures . Dissemination will include open-access peer- review ed publication and academic conference presentations . PROSPERO Registration Number CRD42017049959
target: Some research provided robust analyses of the affected population s ’ health inequities and demonstrated how a task shifting intervention redressed those concerns .
background: Introduction Task shifting interventions have been implemented to improve health and address health inequities .
  Little is known about how inequity and vulnerability are defined and measured in research on task shifting .
  We conducted a systematic review to identify how inequity and vulnerability are identified , defined and measured in  task shifting research from high-income countries .