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Community health workers assisting Latinos manage stress and diabetes (CALMS-D): rationale, intervention design, implementation, and process outcomes

  • Original Research
  • Published:
Translational Behavioral Medicine

Abstract

Latinos have high rates of diabetes and mental distress, but lack appropriate services. A study was designed to compare enhanced standard diabetes care with enhanced standard care plus community health worker (CHW) delivered stress management for Latinos with type 2 diabetes. This paper reports intervention design and process outcomes. A formative process was used to develop and implement an eight-session, group stress management intervention. One hundred twenty-one participants completed baseline assessments; n = 107 attended diabetes education and were then randomized. Recruits reported high credibility and treatment expectancies. Treatment fidelity was high. Participants reported high treatment satisfaction and therapeutic alliance and their diabetes knowledge and affect improved over the short term. Retention and attendance at group sessions was challenging but successful relative to similar trials. This comprehensive and culturally sensitive stress management intervention, delivered by a well-trained CHW, was successfully implemented.

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Acknowledgments

This was an investigator-initiated study funded by a grant from the National Institute of Minority Health and Health Disparities (5R01MD005879-03). The study was also partially supported by a small grant from the Chicago Center for Diabetes Translation Research. JW is supported by a grant from the American Diabetes Association (#7-13-TS-31). The funders played no role in the design, conduct, or analysis of the study, nor in the interpretation and reporting of the study findings. The researchers were independent from the funders. All authors had access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

This study was supported by a grant from the National Institutes of Minority Health and Health Disparities 5 R01 MD005879-03.

Authors’ statement of conflict of interest and adherence to ethical standards

Julie Wagner, Angela Bermudez-Millan, Grace Damio, Sofia Segura-Perez, Jyoti Chhabra, Cunegundo Vergara, and Rafael Perez-Escamilla declare that they have no conflict of interest. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

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Authors and Affiliations

  1. University of Connecticut Health Center, Farmington, CT, USA

    Julie Wagner PhD & Angela Bermudez-Millan PhD

  2. Hispanic Health Council, Hartford, CT, USA

    Grace Damio MS, CD/N & Sofia Segura-Perez MS, RD

  3. Hartford Hospital, Hartford, CT, USA

    Jyoti Chhabra PhD & Cunegundo Vergara MD

  4. Yale School of Public Health, New Haven, CT, USA

    Rafael Perez-Escamilla PhD

Authors
  1. Julie Wagner PhD
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  2. Angela Bermudez-Millan PhD
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  3. Grace Damio MS, CD/N
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  4. Sofia Segura-Perez MS, RD
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  5. Jyoti Chhabra PhD
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  6. Cunegundo Vergara MD
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  7. Rafael Perez-Escamilla PhD
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Corresponding author

Correspondence to Julie Wagner PhD.

Additional information

Implications

Practitioners: Supportive services for people with diabetes—even insured, English speaking patients with transportation and no comorbidities—are lacking in most but tertiary care treatment sites and this study provides evidence that stress management skills can be provided by CHWs.

Policy: The Affordable Care Act formally recognizes the role of CHWs and offers reimbursement for CHW activities including providing culturally and linguistically appropriate health education, thus making uptake of CHW-led interventions more likely.

Researchers: By employing community research staff (rather than a research assistant based at an academic institution), engagement of this population is not only possible, but on par with similar studies not employing community research staff.

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Wagner, J., Bermudez-Millan, A., Damio, G. et al. Community health workers assisting Latinos manage stress and diabetes (CALMS-D): rationale, intervention design, implementation, and process outcomes. Behav. Med. Pract. Policy Res. 5, 415–424 (2015). https://doi.org/10.1007/s13142-015-0332-1

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  • DOI: https://doi.org/10.1007/s13142-015-0332-1

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