Community Health Worker-Led DREAM Intervention Helps South Asian Immigrants Gain Blood Pressure Control
A culturally adapted telehealth intervention led by community health workers (CHWs) improved blood pressure control among South Asian immigrants with co-occurring type 2 diabetes by 33.7% compared to 16.5% in a control group.
CHWs are community members who share the same race, ethnicity, language, and life experiences with the people they serve and provide culturally appropriate health education and informal guidance to improve care access.
In the 6-month trial, 190 first-generation South Asian immigrants aged 18 years to 85 years, living in Atlanta, Georgia, and diagnosed with type 2 diabetes and uncontrolled blood pressure were randomized to the Diabetes Research, Education, and Action for Minorities (DREAM) intervention or a control group. The DREAM Atlanta intervention involved CHWs leading monthly virtual health education group sessions. The five culturally tailored sessions were dedicated to:
- Type 2 diabetes and hypertension overview
- Nutrition with culturally tailored foods
- Exercise specific to gender
- Stress management strategies, including religious practices
- Diabetes and hypertension symptoms and management
The CHWs helped the treatment group participants develop short-term action plans for maintaining healthy diets and physical activity. They also checked in with the participants through progress notes and used motivational interviewing techniques when they talked to them on the phone. Participants in the control group only attended the first telehealth session.
At the 6-month follow-up, 33.7% of the treatment group participants achieved blood pressure control (i.e., 130/80 or lower), compared to a 16.5% improvement in the control group. The treatment group participants also reported significant, positive changes with medication adherence, physical activity engagement, and diet control as part of their type 2 diabetes management.
Researchers say this study is important because South Asian adults, which include individuals with ancestry from India, Bangladesh, Pakistan, Nepal, Bhutan, the Maldives, and Sri Lanka, have higher co-occurring type 2 diabetes and hypertension diagnoses compared to other racial and ethnic minority groups. They are also the fastest-growing ethnic and racial minority group in Georgia and experience high rates of social disadvantages, including limited English proficiency, inadequate access to health insurance and transportation, and lower household incomes.
This study also adds to growing evidence supporting the use of CHWs to provide linguistically and culturally tailored chronic disease management education via telehealth feasible to overcome barriers to care in immigrant communities, such as transportation and irregular schedules.
Citation
Shah, M. K., Wyatt, L. C., Gibbs-Tewary, C., Zanowiak, J. M., Mammen, S., & Islam, N. (2024). A culturally adapted, telehealth, community health worker intervention on blood pressure control among South Asian immigrants with type II diabetes: Results from the DREAM Atlanta intervention. Journal of General Internal Medicine, 39(4), 529-539. https://doi:10.1007/s11606-023-08443-6
Page published Aug. 26, 2024
