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Remote Peer Learning Between US and Cambodian Lay Health Workers to Improve Outcomes for Cambodians with Type 2 Diabetes: a Pilot Study

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Abstract

Background

This paper reports a single-group, pre-post pilot of a peer-learning intervention between community health workers (CHWs) in the USA and Village Health Support Guides (Guides) in Cambodia to improve outcomes for Cambodians with type 2 diabetes (T2D).

Method

Two US-based CHWs were trained in a culturally derived cardiometabolic education curriculum called Eat, Walk, Sleep (EWS) and they were also trained in principles of peer learning. They in turn trained five Cambodia-based Guides remotely through videoconference with a phablet in EWS. Finally, Cambodia-based Guides met with 58 patients with diabetes, face-to-face in their villages, monthly for 6 months to deliver EWS. US-based CHWs and Cambodia-based Guides responded to surveys at baseline and post-treatment. Patients responded to surveys and provided blood pressure and blood samples at baseline and post-treatment.

Results

For US-based CHWs, scores on all surveys of diabetes knowledge, self-evaluation, job satisfaction, and information technology improved, though no statistical tests were run due to sample size. For Cambodia-based Guides, all scores on these same measures improved except for job satisfaction. For patients, n = 60 consented, 2 withdrew, and 7 were lost to follow-up leaving n = 51 for analysis. In paired t tests, patients showed significantly decreased A1c, decreased systolic and diastolic blood pressures, improved attitudes toward medicines, and a trend for switching from all-white to part-brown rice. No changes were detected in self-reported physical activity, medication adherence, sleep quality, or frequency or amount of rice consumed.

Conclusion

If proven effective in a controlled trial, cross-country peer learning could eventually help other diaspora communities.

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Funding

This work was funded by a Research Excellence Program Convergence-2 grant from the University of Connecticut.

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Authors and Affiliations

  1. University of Connecticut Schools of Dental Medicine and Medicine, 263 Farmington Ave., MC3910, Farmington, CT, 06030, USA

    Julie Wagner

  2. University of Connecticut School of Social Work, Hartford, CT, USA

    S. Megan Berthold

  3. University of Connecticut School of Pharmacy, Storrs, CT, USA

    Thomas Buckley

  4. University of Connecticut School of Medicine, Farmington, CT, USA

    Angela Bermudez-Millan & Toan Ha

  5. Khmer Health Advocates, West Hartford, CT, USA

    Mary Scully, Theanvy Kuoch & Sengly Kong

  6. Cambodian Diabetes Association, Siem Reap, Cambodia

    Lorraine Fraser-King, Ien Srey Horn & Lim Keuky

Authors
  1. Julie Wagner
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  2. S. Megan Berthold
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  3. Thomas Buckley
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  4. Angela Bermudez-Millan
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  5. Toan Ha
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  6. Mary Scully
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  7. Theanvy Kuoch
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  8. Sengly Kong
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  9. Lorraine Fraser-King
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  10. Ien Srey Horn
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  11. Lim Keuky
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Corresponding author

Correspondence to Julie Wagner.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study. All procedures involving human participants were approved by the University of Connecticut Institutional Review Board and the Cambodian Ministry of Health, and were in accord with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Wagner, J., Berthold, S.M., Buckley, T. et al. Remote Peer Learning Between US and Cambodian Lay Health Workers to Improve Outcomes for Cambodians with Type 2 Diabetes: a Pilot Study. Int.J. Behav. Med. 27, 609–614 (2020). https://doi.org/10.1007/s12529-020-09896-3

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  • DOI: https://doi.org/10.1007/s12529-020-09896-3

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