Technologically Enhanced Community Health Worker (CHW) Delivery of Personalized D

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DESCRIPTION (provided by applicant): Pharmacological therapy is a critical component of diabetes treatment. Successful medications management requires a partnership between providers who initiate and titrate medications and patients who adhere to the regimen. Yet, there are high rates both of poor medication adherence and failure to intensify medications. Providing adequate information to patients about the potential benefits, harms, costs, and burdens of available medications and discussing patients' treatment preferences and constraints are essential for improved adherence and medication management. This discussion, however, can be too complex and time-consuming for brief clinic visits. Moreover, while there is good, evidence-based information on diabetes medications, such information is often inaccessible to inner-city minority diabetic adults with low health literacy and numeracy, poor or no insurance coverage, and limited English proficiency (LEP). For these adults to make effective medication and other diabetes self-management decisions, they must be able to obtain, process, and apply timely and accurate information for clinical and behavioral decision making. Yet, many lack the tools available to share in decision making or to make an informed decision about their diabetes medications. The Agency for Healthcare Research and Quality (AHRQ) has produced Comparative Effectiveness Research Summary Guides (CERSGs) to help bridge the gap between research and practice by disseminating research findings to patients/consumers, clinicians, and policymakers. Two of these guides, "Pills for Type 2 Diabetes: A Guide for Adults" and "Premixed Insulin for Type 2 Diabetes" summarize research on the nature of diabetes, the role of different aspects of diabetes care, and the benefits and differences among different oral medications and types of insulin. The information in these guides could be of great use to underserved ethnic and racial minority adults in low resource communities to assess their current diabetes treatment and identify opportunities for improvement in their care plan to discuss with their health care providers. First, however, the content presentation and delivery mechanisms of these Guides need to be modified to increase their use and impact among these difficult-to-reach populations. To achieve this goal, a long-standing collaboration among inner-city Detroit African American and Latino community organizations, health care centers and systems, public health organizations, and academics (the REACH Detroit Partnership) is joining with leading experts in the development of personally and culturally tailored health decision aids (University of Michigan's Center for Health Communications Research [CHCR] and Center for Behavioral and Decision Sciences in Medicine [CBDSM]). We propose to develop and evaluate a computer tailored intervention to assist community health workers (CHWs) or other outreach workers to provide personalized patient education materials on oral anti-hyperglycemic medications and insulin to low-literacy, diabetic African American and English- and Spanish-speaking Latino adults with poor glycemic control. PUBLIC HEALTH RELEVANCE: We propose to develop and evaluate in a randomized controlled trial a computer tailored intervention to assist community health workers (CHWs) or other outreach workers to provide personalized patient education materials on oral anti-hyperglycemic medications and insulin to low-literacy, diabetic African American and English and Spanish-speaking Latino adults with poor glycemic control.