Table 12CHWs and health promotion and disease prevention: disease prevention interventions

Author, Year
Study Design
Population Setting
Sample Size
Quality
Intensity of CHW InterventionStudy GroupsResults
Auslander et al., 2002;16
Williams et al., 2001127

RCT

Diabetes prevention

Low-income African-American women in a large city (unspecified) in Missouri

N: 294

Fair
HighG1: 6 group sessions (approximately 6 to 8 participants per group) and 6 individual sessions targeting stages of change to tailor, dietary pattern with a peer educator, meeting weekly over a 3-month period

G2: A book (control)
Food Frequency Questionnaire – Validated:

Intervention was effective in reducing fat intake, as measured by percentage of calories from total fat (baseline/6 months):
G2: 36.0/34.5
G1: 35.9/32.3 (P < 0.05)

BMI: No significant difference between groups

Knowledge of Label Reading
Questionnaire (unvalidated) baseline/6 months:
G2: 5.4/5.7
G1: 5.5/6.3 (P > 0.0001)
Conway, 200467

RCT

Secondary tobacco smoke

Latino neighborhoods in San Diego County, California

N: 143

Fair
HighG1: Culturally relevant home and telephone visits on problem-solving techniques to reduce ETS exposure

G2: No intervention (control)
RIA of child's hair for nicotine and cotinine (validated):

No significant difference between groups
Krieger, 1999105

RCT

Hypertension

Low-income neighborhoods in Seattle, Washington

N: 421

Fair
ModerateG1: CHW assistance with medical followup related to a date when blood pressure was determined to be elevated

G2: Advice to see medical provider, list of public and community clinics
Self-report of completed followup appointment within 90 days (validated by medical provider report):

G1: 65.1%
G2: 46.7% (P = 0.001)
Wendell, 2003117

Prospective cohort study

HIV prevention

At-risk neighborhoods in Louisiana

N: 6,547

Fair
LowG1: Discussions with community members during which they assessed the client’s needs, imparted a risk- or harm-reduction message, answered questions, made referrals, and negotiated and reinforced behavior change

G2: No intervention (control)
Condom use (intervention vs. comparison):

OR, 1.37 (95% CI, 1.20 to 1.56; P < 0.001)
Becker et al., 2005;118
Cene et al., 2008119

RCT

Cardiovascular disease prevention

Baltimore, Maryland

N: 267

Poor
ModerateG1: EPC- received risk-specific materials (same as intervention group), PCP received results and recommendations, sent info on local programs (e.g., YMCA)

G2: CBC - received care in 1 nonclinical site in the community from a NP and CHW. CHW provided dietary counseling, smoking cessation, and exercise counseling lasting 30 minutes.
Smoking cessation (self-report):

G1: 7% reduction
G2: 16.2% reduction (P < 0.001)
Campbell, 2004107

RCT

Colorectal cancer screening

African-American rural churches in North Carolina

NR (12 churches; completers/dropouts of individual participants from each church not reported)

Poor
LowG1: Control churches were offered health education sessions and speakers on topics of their choice not directly related to study objectives

G2: Organize and conduct at least 3 church-wide activities on spreading info and enhancing support for healthy lifestyle and CRC screening (LHA)

G3: 4 personalized computer- tailored newsletters and 4 targeted videotapes corresponding to the same behaviors mailed to participants' homes bimonthly for first 6 months after baseline data collection; 4th mailing was 9 months baseline
G4: LHA + targeted print and videotape
Dietary change—daily fruit and vegetable servings (baseline/followup):

G1: 3.3/3.4
G2: 3.5/3.5
G3: 3.3/3.9
G4: 3.4/3.7
No significant change across arms for LHA interventions

Physical activity—recreational (moderate-vigorous) activity MET hours/week, M (SE) (baseline/followup):

G1: 9.3(0.88)/8.4(0.69)
G2: 10.5(0.9)/10.6(0.70)
G3: 9.5(0.80)/10.9(0.61)
G4: 9.7(0.76)/9.7(0.60)
No significant change across arms for LHA interventions

BMI, body mass index; CBC, community-based care; CHW, community health worker; CI, confidence interval; EPC, enhanced primary care; ETS, environmental tobacco smoke; LHA, lay health advisor; MET, metabolic equivalent; N, number; NP, nurse practitioner; OR, odds ratio; PCP, primary care physician; RCT, randomized controlled trial; RIA, radioimmunoassay; SE, standard error; YMCA, Young Men’s Christian Association.

From: 3, Results

Cover of Outcomes of Community Health Worker Interventions
Outcomes of Community Health Worker Interventions.
Evidence Reports/Technology Assessments, No. 181.
Viswanathan M, Kraschnewski J, Nishikawa B, et al.

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