Comparison of Community Health Worker-Led Diabetes Medication Decision-Making Support for Low-Income Latino and African American Adults With Diabetes Using E-Health Tools Versus Print Materials A Randomized, Controlled Trial

Background: Health care centers serving low-income communities have scarce resources to support medication decision making among patients with poorly controlled diabetes. Objective: To compare outcomes between community health worker use of a tailored, interactive, Web-based, tablet computer-delivered tool (iDecide) and use of print educational materials. Design: Randomized, 2-group trial conducted from 2011 to 2013 (ClinicalTrials.gov: NCT01427660). Setting: Community health center in Detroit, Michigan, serving a Latino and African American low-income population. Participants: 188 adults with a hemoglobin A(1c) value greater than 7.5% (55%) or those who reported questions, concerns, or difficulty taking diabetes medications. Intervention: Participants were randomly assigned to receive a 1- to 2-hour session with a community health worker who used iDecide or printed educational materials and 2 follow-up calls. Measurements: Primary outcomes were changes in knowledge about antihyperglycemic medications, patient-reported medication decisional conflict, and satisfaction with antihyperglycemic medication information. Also examined were changes in diabetes distress, self-efficacy, medication adherence, and hemoglobin A(1c) values. Results: Ninety-four percent of participants completed 3-month follow-up. Both groups improved across most measures. iDecide participants reported greater improvements in satisfaction with medication information (helpfulness, P = 0.007; clarity, P = 0.03) and in diabetes distress compared with the print materials group (P < 0.001). The other outcomes did not differ between the groups. Limitations: The study was conducted at 1 health center during a short period. The community health workers were experienced in behavioral counseling, thereby possibly mitigating the need for additional support tools. Conclusion: Most outcomes were similarly improved among participants receiving both types of decision-making support for diabetes medication. Longer-term evaluations are necessary to determine whether the greater improvements in satisfaction with medication information and diabetes distress achieved in the iDecide group at 3 months translate into better longer-term diabetes outcomes.