Diabetes Forecast

Can Mobile Connections Improve Diabetes Outcomes?

Andrea Cherrington, MD, MPH

When it comes to diabetes, some communities are harder hit than others. Take Birmingham, Ala. The city of 240,000 is 73 percent African American. According to the 2010 census, a quarter of the city's residents are below the poverty line. Statistics like those are bad news when it comes to diabetes: Studies show African Americans are twice as likely to develop diabetes as non-Hispanic whites, and complications such as blindness, kidney disease, and limb loss disproportionately affect the poor.

Andrea Cherrington, MD, MPH
Associate Professor of Medicine, University of Alabama–Birmingham School of Medicine
Public Health
ADA Research Funding
Clinical Translational Award

There's no doubt education can help improve people's health, particularly in communities like Birmingham. But education isn't always easy. Andrea Cherrington, MD, MPH, a physician and professor at the University of Alabama–Birmingham School of Medicine, is looking at one problem in particular—the disconnect between low-income patients and their doctors and diabetes educators. "What patients hear in the clinic may not translate to their everyday lives," says Cherrington.

That's led public-health experts and diabetes educators to reexamine the way they reach out to communities at risk. In recent years, organizations in Birmingham and other American cities have adopted a technique called peer support.

The premise is that people are more likely to listen to their friends and neighbors. By working with community health workers or peer coaches—usually local residents with no formal training, working as volunteers or paid outreach workers—educators hope to reach out through those who share the same experiences as the people in their community with diabetes.

But while peer support shows a lot of promise, it's also got problems. To be most effective, health coaches need to be based in their local communities, not in a clinic. But working alone, often against tremendous odds, the coaches and outreach workers frequently burn out and give up. And because they have limited training in the nuts and bolts of diabetes, "community educators may not have all the answers that a doctor or trained diabetes educator might," Cherrington says.

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She hopes that new technologies can help bridge the gap. With a grant from the American Diabetes Association, Cherrington is creating an app for mobile devices (such as smart phones and tablet computers) that will connect community health workers to one another and to doctors and diabetes educators back in the clinic. "The community health worker could discuss adherence with patients, then use the mobile health tool to communicate back to the provider," she says. The app would also include a chat room for community health workers themselves, to help them share ideas and feel connected.

To test out her approach, Cherrington has linked up with a network of churches in Birmingham's poorest neighborhoods that are already running a community health worker program.

The first phase of the project is designing the app. To fine-tune the program, Cherrington is working closely with a small group of community health workers to make sure she gives them something practical, not just electronic busywork. "A lot of times, paperwork for these coaches becomes quite a burden," she says. "We want to get a lot of feedback as we build the app, so they feel it's a useful tool."

Once the app has been refined, Cherrington will test how well it works. Partnering with the same churches for a pilot study of 72 patients, she'll see if the app helps community health workers make a noticeable difference. "We pair people who have already had diabetes education in a clinic with community health workers to work with them as coaches," she says. Community health workers equipped with the new mobile app will give participants weekly calls for two months, then monthly calls for a year.

To see if the app is making an impact, Cherrington will compare "before" and "after" measurements of things such as blood glucose control and body weight. She'll also interview participants about less tangible factors including quality of life and depression. If regular contact with app-equipped coaches shows promise, a larger study—comparing the results achieved by community health workers using the app with those of workers flying solo—is next. And by pairing 21st-century technology with old-fashioned neighborly advice and outreach, the idea could bring new hope to communities struggling to deal with diabetes.



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