The Role of Community Health Workers to Reduce Health Disparities Using a Multi-Level Integrated Population Health Intervention
Overview
- Phase
- N/A
- Intervention
- Usual Care
- Conditions
- Diabetes
- Sponsor
- Baylor Research Institute
- Enrollment
- 202
- Locations
- 1
- Primary Endpoint
- Allostatic load
- Status
- Completed
- Last Updated
- 2 months ago
Overview
Brief Summary
The primary aim of this study is to determine whether community health worker (CHW) navigation improves outcomes of chronic disease and chronic disease risk factors in a low-income, primarily ethnic minority population when combined with an evidence-based population health model as compared to usual care after 10 months.
Detailed Description
The I-POP+CHW participants will be paired with a CHW at baseline to assist with navigation for 10-months between health and wellness services in the selected zip codes: 75210, 75215, 75216, 75217, 75223, or 75227. Participants will receive a multi-level intervention utilizing the current I-POP Health model that includes: 1) Access to health services (including oral health), 2) Access to clinical prevention services, 3) Access to education and facilities to increase physical activity and improved nutrition choices, and 4) Scheduled visits with CHWs for education and navigation. Individuals will complete study measures at baseline, 6-months, and 10-months. The control group participants will receive access to the same I-POP Health resources without CHW navigation until the end of 10-months (delayed CHW navigation). The current usual care model is outlined below (section 2.3) Participants will complete study measures at baseline, 6-months, and 10-months timepoints. Upon completion of 10-months measures, these individuals will be assigned a CHW and receive delayed navigation.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Age 18 years or older
- •Ability to alter diet and/or physical activity
- •Willing to participate in a 10-month study
- •Resident of selected zip codes: 75210, 75215, 75216, 75217, 75223, or 75227
- •Not having utilized BSW HWC membership services within the past 12 months
- •Not planning to move outside of the selected zip code area within the next 6 months
Exclusion Criteria
- •Below the age of 18 years
- •Unable or unwilling to alter diet and/or physical activity
- •Not willing to participate in a 10-month study
- •Not resident of local selected zip codes: 75210, 75215, 75216, 75217, 75223, or 75227
- •Currently using or have used BSW HWC membership services within the past 12 months
- •Planning to move outside of the selected zip code area within the next 6 months
Arms & Interventions
Control
Control group participants will receive access to the same I-POP Health resources without CHW navigation until the end of 10-months (delayed CHW navigation). The current usual care model is outlined. Participants will complete study measures at baseline, 6-months, and 10-months timepoints. Upon completion of 10-months measures, these individuals will be assigned a CHW and receive delayed navigation.
Intervention: Usual Care
I-POP CHW Intervention
I-POP+CHW participants will be paired with a CHW at baseline to assist with navigation for 10-months between health and wellness services in the selected zip codes: 75210, 75215, 75216, 75217, 75223, or 75227. Participants will receive a multi-level intervention utilizing the current I-POP Health model that includes: 1) Access to health services (including oral health), 2) Access to clinical prevention services, 3) Access to education and facilities to increase physical activity and improved nutrition choices, and 4) Scheduled visits with CHWs for education and navigation. Individuals will complete study measures at baseline, 6-months, and 10-months.
Intervention: I-POP + CHW navigation
Outcomes
Primary Outcomes
Allostatic load
Time Frame: 6-months
A composite score of 10 biomarkers to measure chronic stress and health outcomes. The biomarkers are BMI, waist-to-hip ratio, HDL, TC/HDL ratio, triglycerides, HbA1c, SBP, DBP, C-reactive protein, and cortisol. For each marker a value of 1 will be assigned if that exceed the third quartile except for HDL where a value of 1 will be assigned if lower than first quartile; otherwise a score of zero will be assigned. \[scale: Count of risk factors. May be dichotomized as high risk = 6 to 10, low risk=0 to 5\].
Cortisol
Time Frame: 6-months
4mL saliva collected fasting in the morning. \[Scale: measured in a continuous scale. Normal range 0.007 - 0.115 ug/dL. Value exceeded the normal range indicates higher level of stress.\]
C-Reactive protein
Time Frame: 6-months
4mL saliva collected fasting in the morning. \[Scale: measured in a continuous scale. Normal range 25 pg/mL - 1600 pg/mL. Value exceeded the normal range indicates higher level of inflammation.\]
Body mass index
Time Frame: 10-months
Weight in pounds (lbs) divided by height in inches (in) squared and multiplying by a conversion factor of 703
Waist - to - Hip ratio
Time Frame: 10-months
Waist circumference (centimeters) divided by circumference of hips (centimeters)
HbA1c
Time Frame: 10-months
Finger stick blood measure (%)
Lipids
Time Frame: 10-months
Finger stick blood measure collected fasting via fingerstick (mg/dL)
Blood pressure
Time Frame: 10-months
Stadiometer used to measure systolic and diastolic pressures to nearest 1 mm Hg
C-Reactive protein
Time Frame: Baseline
4mL saliva collected fasting in the morning. \[Scale: measured in a continuous scale. Normal range 25 pg/mL - 1600 pg/mL. Value exceeded the normal range indicates higher level of inflammation.\]
Body mass index
Time Frame: Baseline
Weight in pounds (lbs) divided by height in inches (in) squared and multiplying by a conversion factor of 703
Body mass index
Time Frame: 6-months
Weight in pounds (lbs) divided by height in inches (in) squared and multiplying by a conversion factor of 703
Waist - to - Hip ratio
Time Frame: Baseline
Waist circumference (centimeters) divided by circumference of hips (centimeters)
Waist - to - Hip ratio
Time Frame: 6-months
Waist circumference (centimeters) divided by circumference of hips (centimeters)
HbA1c
Time Frame: Baseline
Finger stick blood measure (%)
HbA1c
Time Frame: 6-months
Finger stick blood measure (%)
Lipids
Time Frame: Baseline
Finger stick blood measure collected fasting via fingerstick (mg/dL)
Lipids
Time Frame: 6-months
Finger stick blood measure collected fasting via fingerstick (mg/dL)
Blood pressure
Time Frame: Baseline
Stadiometer used to measure systolic and diastolic pressures to nearest 1 mm Hg
Blood pressure
Time Frame: 6-months
Stadiometer used to measure systolic and diastolic pressures to nearest 1 mm Hg
Allostatic load
Time Frame: Baseline
A composite score of 10 biomarkers to measure chronic stress and health outcomes. The biomarkers are BMI, waist-to-hip ratio, HDL, TC/HDL ratio, triglycerides, HbA1c, SBP, DBP, C-reactive protein, and cortisol. For each marker a value of 1 will be assigned if that exceed the third quartile except for HDL where a value of 1 will be assigned if lower than first quartile; otherwise a score of zero will be assigned. \[scale: Count of risk factors. May be dichotomized as high risk = 6 to 10, low risk=0 to 5\]
Cortisol
Time Frame: Baseline
4mL saliva collected fasting in the morning. \[Scale: measured in a continuous scale. Normal range 0.007 - 0.115 ug/dL. Value exceeded the normal range indicates higher level of stress.\]
Secondary Outcomes
- Diet(10-months)
- Physical activity(10-months)
- Services utilization(10-months)
- Social determinants(10-months)
- Perceived stress(10-months)
- Medication use(10-months)
- Social determinants(Baseline)
- Social determinants(6-months)
- Perceived stress(Baseline)
- Perceived stress(6-months)
- Medication use(Baseline)
- Medication use(6-months)
- Diet(Baseline)
- Diet(6-months)
- Physical activity(Baseline)
- Physical activity(6-months)
- Services utilization(Baseline)
- Services utilization(6-months)