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Feasibility of a Church-Based, CHW-Delivered Diabetes and SDOH Intervention in a Hispanic Community: A
Elizabeth M Vaughan1,2, Saad Nadeem3, Ashok Balasubramanyam4
1Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA. emvaughan316@gmail.com.
Background:
Social determinants of health (SDOH) screenings have identified disproportionate inequities in Hispanic populations that increase diabetes risk, yet they rarely lead to interventions. Churches are trusted community hubs with the potential to address health needs; however, partnerships with Hispanic churches remain largely unexplored.
Objective:
To assess the feasibility of a church-based, community health worker (CHW)-led program to identify and address SDOH inequities in a Hispanic community.
Design:
Pilot quasi-experimental feasibility study PARTICIPANTS: Forty-seven Hispanic adults, predominantly women (74.5%), with a mean age of 51 years INTERVENTIONS: Five church congregants obtained CHW state certification (160-h course) and received training in teaching skills, diabetes self-management, and SDOH. With ongoing mentoring, CHWs led a 6-month diabetes prevention and self-management program with monthly in-person education and weekly mHealth coaching focused on addressing SDOH inequities in the healthcare access and quality domain.
Main Measures:
Feasibility was assessed across eight pre-established variables (integration, expansion, demand, implementation, limited efficacy, acceptability, practicality, and adaptation), including CHWs' ability to address SDOH inequities such as insurance coverage, established medical home, primary care utilization, eye exams, medication access, and glucose monitoring.
Key Results:
CHWs completed 97.3% of planned weekly mHealth contacts, identified and addressed 92.8% of participant concerns, and conducted all in-person education sessions per protocol. Healthcare access improved significantly: insurance coverage/clinic eligibility (66.0 to 85.1%; p = 0.025), established medical home (61.7 to 91.5%; p < 0.0001), time since last primary care visit (16.2 to 1.4 months; p = 0.017), and annual eye exams (25.0 to 64.3%; p < 0.0001). On a 5-point Likert scale, participants increased access to medications (Δ = 0.54; p = 0.03), medical care (Δ = 0.67; p = 0.012), and a primary care provider (Δ = 0.79; p = 0.009). Among participants with diabetes, glucose monitoring increased from 0.5 to 1.4 times daily (p = 0.017).
Conclusions:
Findings support the feasibility of partnering with Hispanic churches to both identify and address healthcare access SDOH inequities.
