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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP-
dc.contributor.authorNASCIMENTO, Thais Moura Ribeiro do Valle-
dc.contributor.authorRESNICOW, Ken-
dc.contributor.authorNERY, Marcia-
dc.contributor.authorBRENTANI, Alexandra-
dc.contributor.authorKASELITZ, Elizabeth-
dc.contributor.authorAGRAWAL, Pooja-
dc.contributor.authorMAND, Simanjit-
dc.contributor.authorHEISLER, Michele-
dc.identifier.citationBMC HEALTH SERVICES RESEARCH, v.17, article ID 32, 10p, 2017-
dc.description.abstractBackground: Rates of noncommunicable diseases (NCDs) such as type 2 diabetes are escalating in low and middle-income countries such as Brazil. Scalable primary care-based interventions are needed to improve self-management and clinical outcomes of adults with diabetes. This pilot study examines the feasibility, acceptability, and outcomes of training community health agents (CHAs) in Motivational Interviewing (MI)-based counseling for patients with poorly controlled diabetes in a primary care center in Sao Paulo, Brazil. Methods: Nineteen salaried CHAs participated in 32 h of training in MI and behavioral action planning. With support from booster training sessions, they used these skills in their regular monthly home visits over a 6 month period with 57 diabetes patients with baseline HbA1cs > 7.0%. The primary outcome was patients' reports of the quality of diabetes care as measured by the Portuguese version of the Patient Assessment of Chronic Illness Care (PACIC) scale. Secondary outcomes included changes in patients' reported diabetes self-management behaviors and in A1c, blood pressure, cholesterol and triglycerides. We also examined CHAs' fidelity to and experiences with the intervention. Results: Patients reported improvements over the 6 month period in quality of diabetes care received (PACIC score improved 33 (+/-19) to 68 (+/-21) (p < .001)). They reported increases in physical activity (p = .001), consumption of fruits and vegetables (p < .001) and medication adherence (p = .002), but no decreases in consumption of high-fat foods (p = .402) or sweets (p = .436). Participants had mean 6-month A1c levels 0.34% points lower than at baseline (p = .08) and improved mean LDL (-16.1 mg/dL, p = .005) and triglyceride levels (-38.725 mg/dL, p = .002). Of the 16 CHAs observed in fidelity assessments, 13 were categorized as medium-or high-performing on MI skills, while 3 were low-performing. CHAs expressed enthusiasm about learning new skills, and many described a shift from advice-giving to encouraging patients to define their own goals. Conclusion: In resource-scarce settings, it is essential to fully utilize existing primary care resources to stem the epidemic of diabetes and other NCDs. Our pilot results support the potential of training CHAs to incorporate effective diabetes self-management support into their routine patient encounters.-
dc.description.sponsorshipSao Paulo Research Foundation (FAPESP) [2013/10313-6]-
dc.description.sponsorshipNational Institute of Diabetes and Digestive and Kidney Diseases [P30DK092926]-
dc.relation.ispartofBMC Health Services Research-
dc.subjectCommunity health worker-
dc.subjectPilot study-
dc.subjectMotivational Interviewing-
dc.subjectPrimary care-
dc.subject.otherrandomized controlled-trial-
dc.subject.othernoncommunicable diseases-
dc.subject.otherworker intervention-
dc.subject.otherpatient assessment-
dc.titleA pilot study of a Community Health Agent-led type 2 diabetes self-management program using Motivational Interviewing-based approaches in a public primary care center in Sao Paulo, Brazil-
dc.rights.holderCopyright BIOMED CENTRAL LTD-
dc.subject.wosHealth Care Sciences & Services-
dc.type.categoryoriginal article-
dc.type.versionpublishedVersion-, Ken:Univ Michigan, Sch Publ Hlth, Dept Hlth Behav & Hlth Educ, Ann Arbor, MI 48109 USA-, Elizabeth:Univ Michigan, Sch Med, Ann Arbor, MI 48109 USA-, Pooja:Univ Michigan, Sch Med, Ann Arbor, MI 48109 USA-, Simanjit:Univ Michigan, Sch Med, Ann Arbor, MI 48109 USA-, Michele:Univ Michigan, Sch Med, Ann Arbor, MI 48109 USA; Univ Michigan, Sch Med, Dept Internal Med, Ann Arbor, MI 48109 USA; Ann Arbor Vet Affairs VA Healthcare Syst, Ctr Clin Management Res, 1600 Plymouth Dr,Bldg 16, Ann Arbor, MI 48109 USA-
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