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Completed

NCT Number: NCT03394456

Technology to Improve the Health of Resource-poor Hispanics With Diabetes

This study evaluates the efficacy and implementation of a telehealth-supported, integrated diabetes group visit program led by Community Health Workers (CHWs). Primary study relates to efficacy and a secondary study addresses mentored implementation.

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Key information

Conditions

Diabetes Mellitus, Type 2 Diabetes Mellitus Endocrine System Diseases Glucose Metabolism Disorders Metabolic Diseases Nutritional and Metabolic Diseases

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Baylor College of Medicine

Houston, Texas, 77030, United States

About this study

The number of Hispanics diagnosed with diabetes is escalating in the US with disproportionately higher prevalence and complication rates than other ethnicities. CHWs are a well-established and culturally sensitive means to bridge gaps in care to individuals with diabetes. However CHWs are often left unsupported, placing patients at risk of substandard care or harm. Telehealth is a term used to describe a range of technologies to support healthcare delivery via communication with the patient or a member of the healthcare delivery team. Though telehealth has been implemented into diabetes programs for many years, there is a paucity of data showing the use of telemedicine for CHW training and support.

The primary study (n=89; Cohorts 1,2) compares clinical outcomes and treatment satisfaction of individuals who receive diabetes care in a 12-month telehealth supported, integrated CHW-led group visit program compared to those in usual care (wait list control). Group visits are 6-months and CHWs contact patients weekly to bimonthly (mobile health (mHealth)) for 12-months. This phase with have two cohort waves, separated by 6-months. The wait list control group for Cohort 2 will explore telehealth, clinician-patient encounters. A secondary study (n=59; Cohorts 3,4) at a new clinic evaluates the ability to implement the program. In the first phase of the secondary study the research team will conduct a RCT of individuals randomized to the diabetes program (intervention) vs usual care (control) to assess clinic feasibility. The clinic team will observe this process and learn the project protocols during Phase 1. In the second phase, the clinic team will lead the group visits while the research team mentors them to conduct the project in-person at the group visits and via telehealth each week (ZOOM video conferencing). Another secondary study (n=138; Cohort 5) aims to expand the reach of the education and CHW intervention for individuals who may not be able to or cannot come to the clinic for group visits. Specifically, individuals will received the education from the program monthly via a secure text message video, CHWs will contact weekly to bimonthly to advocate for their needs, and participants will receive their routine care as usual in the clinic.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Hispanic adults with diabetes, low-income (earn less than/equal to 250% federal poverty level)

Exclusion criteria

  • not able to understand Spanish, group visit is not appropriate for care i.e., need individualized care, pregnancy, etc

Treatment and study plan

diabetes program

Other

Comprehensive diabetes program (weekly to bimonthly CHW mHealth contact (phone, text) for 12-months and monthly diabetes group visits for 6-months)

telehealth training and support for Community Health Workers

Other

weekly 1-hour diabetes training and patient support for CHWs via telehealth i.e., ZOOM technology for the study duration

Primary outcomes

  1. Glycemic control

    Time frame: At baseline and every 6-months until study completion

    Hemoglobin A1c (%)

Secondary outcomes

  1. Adherence to preventive care guidelines

    Time frame: pre/post diabetes group visits

    As measured by placement on a statin, annual urine micro albumin, target A1c, weight loss (if applicable), retinal eye examination, blood pressure targets, serum B12 measurements, vaccinations.

  2. Survey

    Time frame: at the beginning and end of each cohort (baseline, six-months)

    The survey totaled 12 questions and assessed participant satisfaction, mental relaxation, faith/spirituality, and open-ended comments. Questions were ranked as followed: 1-3 (4-point Likert Scale), 4-7 (10-point Likert Scale), 8-11 (open-ended, descriptive), 12 (days of exercise/week). The Use of Mental Stress Management/Relaxation Techniques questionnaire and our pilot study survey templates were used to evaluate patient group visit and CHW satisfaction. We defined acceptability as high (3.5-4/4 or 8-10/10), moderate (2-3.4/4 or 4-7/10), and low (1-1.9/4 or 1-3/10) and totaled the items to create an overall score.

  3. Diabetes-related health

    Time frame: at the beginning and end of each cohort (baseline, six-months)

    As measured by the Self Management Resource Center Surveys: Diabetes Medications (a 4-question yes/no survey to assess patient medication adherence and understanding of their medications), Self-rated Health (a 1-question ranked on a 5-point scale (1 is excellent, 5 is poor) to determine the patient's view of their health)

  4. Body Mass Index (BMI)

    Time frame: At baseline and every 6-month until study completion

    Body Mass Index (BMI) (weight in kg/height in m^2)

  5. Blood Pressure

    Time frame: At baseline and every 6-month until study completion

    Blood Pressure (mmHg)

  6. Barriers to care

    Time frame: weekly to bimonthly from baseline to 12-months

    We obtain barriers to care data from the CHW-patient mobile health (mHealth) records and chart review, and group into three categories: obtaining medications, appointment access, clinic eligibility. mHealth records were sent to the study physician through a secure, encrypted site on a weekly basis.

  7. longitudinal outcomes

    Time frame: from the time group visits end and as long as month-24 after

    conduct a chart review to determine long-term (until 24-months post group visits) clinical outcomes including blood pressure (mmHg)

  8. longitudinal outcomes

    Time frame: from the time group visits end and as long as month-24 after

    conduct a chart review to determine long-term (until 24-months post group visits) clinical outcomes including HbA1c (%)

  9. longitudinal outcomes

    Time frame: from the time group visits end and as long as month-24 after

    conduct a chart review to determine long-term (until 24-months post group visits) clinical outcomes including BMI (kg/m^2)

Other outcomes

  1. Feasibility and acceptability of telehealth patient, clinician encounters during diabetes group visits

    Time frame: At six months after group visits for wait list control Cohort 2

    As measured by the Telehealth Usability Questionnaire(21-question survey where 1 is strongly disagree and 5 is strongly agree)

  2. Feasibility and acceptability of telehealth support for community health workers 2

    Time frame: At baseline and six months during Cohort 1 intervention group

    The Diabetes Knowledge Test (University of Michigan, 2015; 23 questions; where a total score of 0 indicates the least and 23 indicates the most diabetes knowledge based on this test)

  3. Feasibility and acceptability of telemedicine support for community health workers

    Time frame: After each cohort (every six months)

    As measured by a six-month 4-question survey (four open-ended questions i.e., what CHWs liked, disliked, general comments) and a 10-question multiple choice posttest that covers content they were taught the last six months (Vaughan et al, 2018)

  4. Feasibility and acceptability of telemedicine support for community health workers

    Time frame: After Cohort 1

    As measured by the Telehealth Usability Questionnaire(21-question survey where 1 is strongly disagree and 5 is strongly agree)

  5. CHW knowledge

    Time frame: During Cohort 2 at baseline (TEST-1 pretest), 6- (TEST-1 posttest, TEST-2 pretest) and 12-months (TEST-2 posttest)

    As measured by pre- /post-tests. TEST-1 (n=21 questions) and TEST-2 (n=19 questions). Tests were multiple choice with 3-5 answer option and were original to this study.

  6. CHW knowledge

    Time frame: During the secondary study, at baseline and 6-months (pre/posttest)

    This will be accomplished by the 24-question Starr County Diabetes Knowledge Test, which has shown validity and reliability in English and Spanish. Each of the 24-question has three answer choices. This will be pre/posttest format.

  7. Access to care

    Time frame: from baseline to 12-months

    As measured by the amount of contact participants had with the clinic during the intervention

Sponsors and collaborators

Lead sponsor

Baylor College of Medicine

Other

Collaborators

  • National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Registry information

Important dates

Study start
2018
Primary completion
2022
Study completion
2022
First posted
Jan 9, 2018
Registry last updated
Sep 28, 2022

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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