La salud de la gente es un derecho humano. | We believe health care is a basic human right. La salud de la gente es un derecho humano.We believe health

La salud de la gente es un derecho humano. | We believe health care is a basic human right.La salud de la gente es un derecho humano. We believe health care is a basic human right.

iDecide/Decido Decision AidThe role of community health workers in the development and delivery of a tailored, interactive, web-based decision aid to low-income Latino and African American adults with poorly controlled type 2 diabetes who received care at a federally qualified health center in DetroitPresenter: Gloria Palmisano

APHA 142nd Annual Meeting & Expo (November 15 - 19, 2014) New Orleans, LA

La salud de la gente es un derecho humano. | We believe health care is a basic human right.La salud de la gente es un derecho humano. | We believe health care is a basic human right.

Disclosures and Funding Sources

Gloria Palmisano

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No relationships to disclose

AHRQ R18 DK078558

NIDDK R18 HS019256

NIDDK P30DK092926 (MCDTR)


Background

• People with diabetes need adequate information about potential benefits, harms, costs, and burdens of medications to make good medication decisions

• This discussion is too time-consuming for clinic visits

• Many adults with diabetes lack resources to share in decision making or make an informed decision about their diabetes medications

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La salud de la gente es un derecho humano. | We believe health care is a basic human right.La salud de la gente es un derecho humano. | We believe health care is a basic human right. 4

Can CHWs better support diabetes medication decision-making when using a tailored,

interactive web-based tool (iDecide) versus using print

educational materials?


Goals of the Study

Aim 1: Work together to build an interactive, computer tailored diabetes medication decision aid to help people:

• Assess their treatment goals

• Identify personal preferences and side-effect concerns

• Understand options for improving their diabetes care (when appropriate)

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Goals of the Study (Continued)

Aim 2: Compare tool with print guides on participant:

– Knowledge of medications

– Satisfaction with information

– Decisional conflict

Aim 3: Look at how the tool affects:– Participant changes in medications

– Self-reported medication adherence

– Participant beliefs about medication

– A1C levels between baseline and follow-up

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Kate Barr, MPH


Basis for Developing Interactive Web-Based Tool

• Agency for Healthcare Research and Quality (AHRQ) produced two consumer-focused guides, “Pills for Type 2 Diabetes” and "Premixed Insulin for Type 2 Diabetes“.

• The presentation of content and delivery of these guides needed to be modified to increase their use and impact among difficult-to-reach populations.

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Development of iDecide/Decido Decision Aid

Community-based participatory research (CBPR)

User-centered design (UCD)

Community health worker model

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CHW Role in Development iDecide/Decido Claudia….”I was a part of the entire process”. ”My main role in the development of the tool was to use my experience with the community to ensure that the material was culturally and linguistically appropriate in both English and Spanish”.

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CHW Role in Development iDecide/Decido

Deliana…”to bring my personal knowledge and experiences of working with the Latino community with type 2 diabetes in regards to how they take care of their diabetes, barriers to managing diabetes, and using that knowledge and those experiences to develop this new intervention and how it would work best in our Latino community. Examples of the roles that I played were ensure that the decision aid and intervention protocols were appropriate for the target population. Assisting with the Spanish translation and making sure that the Spanish used reflected the Spanish that was spoken by the majority of our clients. Selecting pictures and animation that again reflected our community. Assisted in the development of protocols and their translation”.

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Results

Design concept

Animations

Pictographs

Issue cards

Goal setting

Tailoring

Additional CHW tools

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La salud de la gente es un derecho humano. | We believe health care is a basic human right.

SupportValues

Physical Activity

Confidence AdherenceConcerns

Lab Values

CurrentMeds

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Glucose and Insulin Characters

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Description of iDecide/Decido InterventionCHW delivered intervention to improve satisfaction with and knowledge of diabetes medications 2 arms (n=188)

• Control group: reviews the static, paper AHRQ patient guide with a CHW

• Intervention group: reviews the tailored, web-based program with a CHW

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Kate Barr, MPH


Results• CHW recommendations contributed to tool being culturally and

linguistically appropriate and tailored to needs of community

• Of the 188 participants, 176 completed follow-up

• Both groups significantly improved across most measures

• iDecide participants reported greater improvements in satisfaction with medication information (p=.006) and in diabetes distress (p=0.002) compared to print materials group

• Only iDecide participants had improvements in A1c from baseline (-0.4%, p=0.002)

• were more likely to maintain or achieve an A1c<=7% (p<0.05) • a high level of self-efficacy (p<0.01)• a low level of diabetes distress (p<0.01)

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Conclusion

• The combination of CBPR and UCD approaches can serve as an effective model for developing web-based interventions that are efficient, easy to use, and utilize the skills and knowledge of community members, while also meeting the needs of the communities being served.

• Interactive, tailored web-based tools developed in collaboration with CHWs and delivered by CHWs may improve the effectiveness of CHW diabetes decision support and coaching.

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Animations- Quick Look

•http://yertle.chcr.med.umich.edu/chcr/documents/iDecide_demo/


Acknowledgements

La salud de la gente es un derecho humano. | We believe health care is a basic human right.La salud de la gente es un derecho humano. We believe health care is a basic human right.

Thank YouGloria Palmisano

[email protected]

Documents

La salud de la gente es un derecho humano. | We believe health care is a basic human right. La salud de la gente es un derecho humano.We believe health