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A Systematic Review of Community Health Center Based Interventions for People with Diabetes

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Abstract

Community health centers (CHCs) focus on serving socioeconomically disadvantaged populations with heightened chronic disease burden, making CHCs an ideal setting for implementing diabetes care programs that target vulnerable populations. We aimed to synthesize evidence concerning the effects of CHC interventions in people with diabetes. To do this, four electronic databases were searched, including PubMed, EMBASE, CINAHL, and Scopus, and hand searches of reference collections were undertaken to identify intervention trials published in English. We screened 892 unique titles and abstracts. Two reviewers then independently evaluated 221 full-text articles. We discovered 29 articles met our eligibility criteria for inclusion. We found 27 unique studies with two companion articles. Seventeen studies were randomized controlled trials and the majority had a higher proportion of female and racial/ethnic minorities in the study sample. CHC interventions often involved either one-on-one or group education sessions supplemented by a phone follow-up that were delivered by health providers, nutritionists, or community health workers. CHC interventions using education sessions combined with follow up via phone generally resulted in significant improvements in hemoglobin A1C, while sole telephone-based education studies showed no significant improvements. CHC interventions had no significant effects on physical activity in all six studies that examined the outcome. Overall, we found that CHC interventions were in general effective in improving glucose control when using face-to-face interactions in low-income, underserved, and racial and ethnic minority patients with diabetes. Evidence was limited, however, in regards to other outcomes which suggests the need for continued evaluations of CHC intervention models.

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Funding

This study was supported by a grant from the Brancati Center for the Advancement of Community Care. Additional resources were provided by Center for Cardiovascular and Chronic Care and Center for Community Innovation and Scholarship at the Johns Hopkins University.

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Authors and Affiliations

  1. School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, 21205, USA

    Hae-Ra Han, Siobhan McKenna, Manka Nkimbeng, Patty Wilson, Sally Rives, Olayinka Ajomagberin, Mohammad Alkawaldeh, Kelli Grunstra & Phyllis Sharps

  2. Center for Cardiovascular and Chronic Care, The Johns Hopkins University, Baltimore, MD, 21205, USA

    Hae-Ra Han

  3. Center for Community Innovation and Scholarship, The Johns Hopkins University, Baltimore, MD, 21205, USA

    Hae-Ra Han, Patty Wilson, Olayinka Ajomagberin & Phyllis Sharps

  4. School of Medicine, The Johns Hopkins University, 733 N. Broadway, Baltimore, MD, 21205, USA

    Nisa Maruthur

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Contributions

Conceived and designed the study: HRH. Conducted the literature search and screening/inclusion process: SM, SR, MN. Conducted the data extraction: SM, SR, OA, KG. Analyzed the data: HRH, SM, PW. Contributed analysis: MN, MA. Wrote the paper: HRH, SM, MN, PW. Contributed to the revision process: HRH, SM, MN, PW, SR, OA, MA, KG, NM, PS.

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Correspondence to Hae-Ra Han.

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Han, HR., McKenna, S., Nkimbeng, M. et al. A Systematic Review of Community Health Center Based Interventions for People with Diabetes. J Community Health 44, 1253–1280 (2019). https://doi.org/10.1007/s10900-019-00693-y

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