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Health Promot Pract. 2015 Jul;16(4):601-8. doi: 10.1177/1524839914557033. Epub 2014 Nov 5.

A Community Health Worker Intervention for Diabetes Self-Management Among the Tz'utujil Maya of Guatemala.

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Emory University, Atlanta, GA, USA
Emory University, Atlanta, GA, USA.
Duke University Medical Center, Durham, NC, USA.
Medical Anthropologist, Atlanta, GA, USA.
Organization for the Development of the Indigenous Maya, San Juan La Laguna, Guatemala.


Despite the high prevalence of diabetes in rural Guatemala, there is little education in diabetes self-management, particularly among the indigenous population. To address this need, a culturally relevant education intervention for diabetic patients was developed and implemented in two rural communities in Guatemala. An evaluative research project was designed to investigate if the structured, community-led diabetes self-management intervention improved selected health outcomes for participants. A one-group, pretest-posttest design was used to evaluate the effectiveness of the educational intervention by comparing measures of health, knowledge, and behavior in patients pre- and postintervention. A survey instrument assessed health beliefs and practices and hemoglobin A1c (HgA1c) measured blood glucose levels at baseline and 4 months post initiation of intervention (n = 52). There was a significant decrease (1.2%) in the main outcome measure, mean HgA1c from baseline (10.1%) and follow-up (8.9%; p = .001). Other survey findings were not statistically significant. This study illustrates that a culturally specific, diabetes self-management program led by community health workers may reduce HgA1c levels in rural populations of Guatemala. However, as a random sample was not feasible for this study, this finding should be interpreted with caution. Limitations unique to the setting and patient population are discussed in this article.


chronic disease; diabetes; health education; health promotion; international/cross-cultural health

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