Community Health Workers in Diabetes Prevention and Management in Developing Countries

BackgroundThere is limited evidence regarding the effect of community health worker (CHW) interventions for prevention and management of the burgeoning epidemic of noncommunicable diseases (NCDs) in low- and middle-income countries (LMICs). The objective of this review was to critically appraise evidence regarding the effectiveness of CHW interventions for prevention and management of type 2 diabetes mellitus (T2DM) in LMICs.MethodsTo identify studies that reported the effect of CHW interventions for prevention and management of T2DM in LMICs, Medline/PubMed, EMBASE, Web of Science (Science and Social Science Citation Indices), EBSCO (PsycINFO and CINAHL), POPLINE, the Cochrane Metabolic and Endocrine Disorders Group's Specialized Register, the Cochrane Central Register of Controlled Trials, the Grey literature (Google, Google Scholar), and reference lists of identified articles were searched from inception to May 31, 2017.FindingsTen studies were included (4 pre- and post-studies, 2 randomized controlled trials, 2 cohort studies, 1 cross-sectional study, and 1 case-control study). The role of CHWs consisted of patient education, identification and referral of high-risk individuals to physicians, and provision of social support through home visits. Positive outcomes were reported in 7 of 10 studies. These outcomes included increased knowledge of T2DM symptoms and prevention measures; increased adoption of treatment-seeking and prevention measures; increased medication adherence; and improved fasting blood sugar, glycated hemoglobin, and body mass index. Three studies showed no significant outcomes.ConclusionsCHWs have the potential to improve knowledge, health behavior, and health outcomes related to prevention and management of T2DM in LMICs. Given the limited number of studies included in this review, robust conclusions cannot be drawn at the present time

Intercultural Health and the Mapuche: Perceptions and Practice in Santiago, Chile

Background: Intercultural health (IH), defined as the integration of western and indigenous medicine, is a public health approach that aims to reduce the divide between indigenous and biomedical health systems based on mutual respect and equal recognition of both knowledge systems. In Chile, IH has become a national strategy of indigenous health improvement through the Programa Especial de Salud y Pueblos Indígenas. With increasing Mapuche populations in urban centers, it is important to understand how these initiatives are conceptualized in urban settings. Methods: Through a qualitative assessment consisting of 10 in-depth, semi-structured interviews, this project sought to understand how IH is implemented in the La Florida municipality of the Metropolitan Region. Results: Results revealed that the current IH model is inadequate to meet the needs of the urban indigenous population. Constitutional recognition of the Mapuche people and culture was considered a prerequisite to restructure the IH model. Issues such as lack of funding, political favoritism, and a fundamental misunderstanding of Mapuche culture were seen as challenges to improving IH programs and indigenous health outcomes. Conclusion: Efforts to improve IH must take into account the indigenous concept of health and healthcare without forcing it into a biomedical model. A more comprehensive curriculum of indigenous healthcare and culture in general and medical education is critical to improve cross-cultural collaboration. An evaluation framework for funding mechanisms of IH at the regional level is needed to improve transparency and accountability among the Servicios de Salud, or Regional Health Departments, and indigenous associations. More research should be conducted in other urban areas with high indigenous populations to gather more representative data on IH implementation in the Metropolitan Region

Community Health Workers in Diabetes Prevention and Management in Developing Countries

There is limited evidence regarding the effect of community health worker (CHW) interventions for prevention and management of the burgeoning epidemic of noncommunicable diseases (NCDs) in low- and middle-income countries (LMICs). The objective of this review was to critically appraise evidence regarding the effectiveness of CHW interventions for prevention and management of type 2 diabetes mellitus (T2DM) in LMICs. To identify studies that reported the effect of CHW interventions for prevention and management of T2DM in LMICs, Medline/PubMed, EMBASE, Web of Science (Science and Social Science Citation Indices), EBSCO (PsycINFO and CINAHL), POPLINE, the Cochrane Metabolic and Endocrine Disorders Group's Specialized Register, the Cochrane Central Register of Controlled Trials, the Grey literature (Google, Google Scholar), and reference lists of identified articles were searched from inception to May 31, 2017. Ten studies were included (4 pre- and post-studies, 2 randomized controlled trials, 2 cohort studies, 1 cross-sectional study, and 1 case-control study). The role of CHWs consisted of patient education, identification and referral of high-risk individuals to physicians, and provision of social support through home visits. Positive outcomes were reported in 7 of 10 studies. These outcomes included increased knowledge of T2DM symptoms and prevention measures; increased adoption of treatment-seeking and prevention measures; increased medication adherence; and improved fasting blood sugar, glycated hemoglobin, and body mass index. Three studies showed no significant outcomes. CHWs have the potential to improve knowledge, health behavior, and health outcomes related to prevention and management of T2DM in LMICs. Given the limited number of studies included in this review, robust conclusions cannot be drawn at the present time.Open access article.This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]