Using path analysis to model the process of change in HbA1c among African Americans and Latinos in a community health worker diabetes intervention

Alana M W LeBrón; Nicolaus R Espitia; Edith C Kieffer; Brandy R Sinco; Jaclynn M Hawkins; Emily J Nicklett; Gloria Palmisano; Michele Heisler; Michael S Spencer

doi:10.1016/j.pec.2021.11.025

Using path analysis to model the process of change in HbA1c among African Americans and Latinos in a community health worker diabetes intervention

Patient Educ Couns. 2022 Jul;105(7):2166-2173. doi: 10.1016/j.pec.2021.11.025. Epub 2021 Nov 28.

Authors

Alana M W LeBrón¹, Nicolaus R Espitia², Edith C Kieffer², Brandy R Sinco³, Jaclynn M Hawkins², Emily J Nicklett⁴, Gloria Palmisano⁵, Michele Heisler⁶, Michael S Spencer⁷

Affiliations

¹ Department of Health, Society, and Behavior, University of California, Irvine, Irvine, CA, USA; Department of Chicano/Latino Studies, University of California, Irvine, Irvine, CA, USA. Electronic address: [email protected].
² School of Social Work, University of Michigan, Ann Arbor, MI, USA.
³ School of Medicine, University of Michigan, Ann Arbor, MI, USA.
⁴ Department of Social Work, University of Texas San Antonio, San Antonio, TX, USA.
⁵ Community Health and Social Services Inc. (CHASS), Detroit, MI, USA.
⁶ School of Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Health Education and Behavior, University of Michigan, Ann Arbor, MI, USA; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
⁷ School of Social Work, University of Washington, Seattle, WA, USA.

PMID: 34903389
DOI: 10.1016/j.pec.2021.11.025

Abstract

Objective: To examine which components of a culturally tailored community health worker (CHW) intervention improved glycemic control and intermediate outcomes among Latina/o and African American participants with diabetes.

Methods: The sample included 326 African American and Latina/o adults with type 2 diabetes in Detroit, MI. CHWs provided interactive group diabetes self-management classes and home visits, and accompanied clients to a clinic visit during the 6-month intervention period. We used path analysis to model the processes by which each intervention component affected change in diabetes self-efficacy, diabetes-related distress, knowledge of diabetes management, and HbA1c.

Results: The group-based healthy lifestyle component was significantly associated with improved knowledge. The group-based self-management section was significantly associated with reduced diabetes-related distress. Intervention class attendance was positively associated with self-efficacy. Diabetes self-management mediated the reductions in HbA1c associated with reductions in diabetes distress.

Conclusions: Path analysis allowed each potential pathway of change in the intervention to be simultaneously analyzed to identify which aspects of the CHW intervention contributed to changes in diabetes-related behaviors and outcomes among African Americans and Latinas/os.

Practice implications: Findings reinforce the importance of interactive group sessions in efforts to improve diabetes management and outcomes among Latina/o and African American adults with diabetes.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Adult
Black or African American
Community Health Workers*
Diabetes Mellitus, Type 2* / therapy
Glycated Hemoglobin / analysis
Hispanic or Latino
Humans
Self Care

Substances

Glycated Hemoglobin A

Grants and funding

P30 DK092926/DK/NIDDK NIH HHS/United States