Tools and Practices to Decrease CVD and Complications in the Diabetic Population of Mexico

DESCRIPTION (provided by applicant): The current proposed research will focus on the prevention of cardiovascular disease (CVD) and its complications among adults with diabetes in Northern Mexico. One major component of the study will assess the effectiveness of an adapted evidence-based community health worker intervention, Meta Salud Diabetes, at reducing behavioral and clinical risk for cardiovascular disease among adults with diabetes in Sonora, Mexico. We will conduct a cluster-randomized trial among adult patients with diabetes sampled from 20 Secretaria de Salud (Secretary of Health)-operated health centers in Sonora. Existing community health workers at each of ten health centers randomized to the intervention condition will be trained in the adapted CVD prevention curriculum. The community health workers will then enroll 20 participants with diabetes at each site into the 12-week intervention. Psychosocial (e.g., knowledge, attitudes, and beliefs) and behavioral (e.g., smoking, healthy eating) risk factors for cardiovascular disease will be assessed via self-administered surveys during the first of the 12 weekly educational sessions. Clinical risk factors (i.e., BMI, blood pressure, lipids, blood sugar) will be abstracted from existing patient records at the health centers. We will then assess changes that occur at three months (immediately after the 12-week intervention) and 12 months. Changes in the intervention clinic will be compared to changes over the same time period among adult patients with diabetes in each of ten health centers randomized to the control condition (i.e., the usual standard of care). We define the intervention effect as changes over time that occur among intervention participants net of changes over time among diabetic patients at control health centers. We further propose a second component of the study that will consist of systematic engagement of local, state and national decision makers essential to scale up and sustain the intervention into the standard package of services offered by government-run health centers in Sonora and other Mexican states. These government-run health centers, like those where our cluster randomized trials are executed, represent an ideal system for scale-up of Meta Salud Diabetes and other evidenced-based community health worker interventions, since most Mexicans are eligible and receive care at these health centers and because Mexico's centralized health care system will greatly facilitate system wide integration. Extensive qualitative and descriptive data will be collected on the facilitators and barriers to adopt and integrate community health worker chronic disease interventions throughout Sonoran health centers and other health care systems serving high risk populations in Mexico.