Training Community Health Workers as Diabetes Educators for Urban African Americans: Value Added Using Participatory Methods

Background: With growing use of Community Health Workers (CHWs) to reach underserved populations, there is a need for more information on training methods to prepare CHWs, particularly in a health educator role.

Objectives: To describe procedures used to recruit, train, and evaluate CHWs in Project Sugar 2, a randomized controlled trial of a nurse case manager and CHW team intervention designed to improve diabetes care and control in a sample of 542 urban African Americans with type 2 diabetes.

Methods:CHWs received a Core Training on guidelines and procedures, didactic diabetes self-management education, and research protocol training. However, barriers to CHW implementation of the intervention were encountered, including CHW attrition, job performance and satisfaction issues, low self-confidence in knowledge and skills as educators, difficulties with maintaining a large caseload, and inefficiencies experienced in conducting home visits. To address barriers, the initial training was modified and

Results: The supplemental training resulted in CHW retention, satisfaction, confidence in skills, and feelings of ownership of the intervention. Participant satisfaction with care received from the CHWs and the Project Sugar 2 intervention was rated as high by 97% and 93% of responders, respectively.

Conclusion: Core training in research intervention policies, procedures, and protocols, combined with an extended participatory training, led to effective preparation of laypersons to serve as CHWs.