Reports From the Field

Evaluation of a Diabetes Care Coordination Program for African-American Women Living in Public Housing

Journal of Clinical Outcomes Management. 2015 August;22(8)

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Recommendations for Future Research and Practice

There are several recommendations for future research and practice. First, to achieve stronger clinical health outcomes, the DCCP would need to be enhanced by assuring lower caseloads for the WSHC clinical team. Second, to expand the evidence base, stronger experimental designs are needed to draw firmer conclusions about causal relationships. For instance, a multiple-baseline design across similar federally qualified heath centers could enable a better understanding of the effects of this community-based DCCP intervention in urban contexts. Third, research and practice would benefit from further testing of the model using community health workers for delivery of DSME and DSMS services. Fourth, implementation science can aid in enhancing the role of Ambassadors by providing tools/frameworks for improved delivery of services such as the core implementation components of selection and training [23]. Finally, the use of behavioral science methods can help extend the evidence base for the effects of the DCCP intervention on behavior change at the individual and the community levels [24,25].

Conclusion

This empirical case study adds to our understanding of delivering community-based diabetes care in a public housing context. This study examined the implementation and effects of a diabetes program for African-American women experiencing health disparities. The delivery of diabetes services by Diabetes Health Ambassadors was effective in engaging women with diabetes who lived in low-income housing. This study provided further evidence that coordinated diabetes care, with a focus on culturally and contextually appropriate service delivery, can have positive health outcomes. Further research is needed to examine effects of the DCCP intervention at the individual, clinic, family, and community levels.

Addressing the rapidly increasing prevalence of diabetes is a huge challenge, especially among vulnerable populations at disproportionate risk for adverse health outcomes. These patients face physical, emotional, and financial burdens. We need to assure that community health workers and coordinated clinical teams are prepared to support patients’ acquisition and maintenance of self-care behaviors. Eliminating diabetes-related disparities requires modifying the health system and the broader community environment [26]. Addressing the barriers to medical and self-care that vulnerable populations with type 2 diabetes face will provide them with greater opportunities for health and well-being.

Acknowledgments: The authors thank the many community partners throughout Boston that made this project possible.

Corresponding author: Ithar Hassaballa, KU Work Group for Community Health and Development, University of Kansas, 1000 Sunnyside Ave, 4082 Dole Center, Lawrence, KS 66045, ithar@ku.edu.

Funding/support: Funding for the Whittier Street Health Center’s Diabetes Care Coordination Program and for the evaluation of the Together on Diabetes initiative was provided by the Bristol-Myers Squibb Foundation.

Financial disclosures: None.