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A Home-Based Educational Intervention Improves Patient Activation Measures and Diabetes Health Indicators among Zuni Indians

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  • Vallabh O Shah
  • Casey Carroll
  • Ryan Mals
  • Donica Ghahate
  • Jeanette Bobelu
  • Phillip Sandy
  • Kathleen Colleran
  • Ronald Schrader
  • Thomas Faber
  • Mark R Burge

Abstract

Introduction: One in three people will be diagnosed with diabetes by 2050, and the proportion will likely be higher among Native Americans. Diabetes control is currently suboptimal in underserved populations despite a plethora of new therapies. Patient empowerment is a key determinant of diabetes control, but such empowerment can be difficult to achieve due to resource limitation and cultural, language and health literacy barriers. We describe a home-based educational intervention using Community Health Representatives (CHRs), leading to improvement in Patient Activation Measures scores and clinical indicators of diabetes control. Methods: Sixty participants with type 2 diabetes (T2D) completed a baseline evaluation including physical exam, Point of Care (POC) testing, and the Patient Activation Measure (PAM) survey. Participants then underwent a one hour group didactic session led by Community Health Representatives (CHRs) who subsequently carried out monthly home-based educational interventions to encourage healthy lifestyles, including diet, exercise, and alcohol and cigarette avoidance until follow up at 6 months, when clinical phenotyping and the PAM survey were repeated. Results: PAM scores were increased by at least one level in 35 (58%) participants, while 24 participants who started at higher baseline score did not change. Six months after intervention, mean levels of A1C decreased by 0.7 ± 1.2%; fasting blood glucose decreased by 24.0 ± 38.0 mg/dl; BMI decreased by 1.5 ± 2.1 kg/m2; total cholesterol decreased by 12.0± 28.0 mg/dl; and triglycerides decreased by 52.0 ± 71.0 mg/dl. All of these changes were statistically significant (p

Suggested Citation

  • Vallabh O Shah & Casey Carroll & Ryan Mals & Donica Ghahate & Jeanette Bobelu & Phillip Sandy & Kathleen Colleran & Ronald Schrader & Thomas Faber & Mark R Burge, 2015. "A Home-Based Educational Intervention Improves Patient Activation Measures and Diabetes Health Indicators among Zuni Indians," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-14, May.
    • Handle: RePEc:plo:pone00:0125820
    DOI: 10.1371/journal.pone.0125820
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    1. Moore, K. & Jiang, L. & Manson, S.M. & Beals, J. & Henderson, W. & Pratte, K. & Acton, K.J. & Roubideaux, Y., 2014. "Case management to reduce cardiovascular disease risk in American Indians and Alaska Natives with diabetes: Results from the special diabetes program for Indians healthy heart demonstration project," American Journal of Public Health, American Public Health Association, vol. 104(11), pages 158-164.
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