• The impact of trained community health workers on health care utilization and quality of life for diabetic Medicaid enrollees

      Chang, Ruyu; Fedder, Donald O. (1995)
      Volunteer Community Health Workers (CHW) have been used in the United States in various capacities, but their effectiveness have not been well established. The goal of the study was to measure the impact of the Community Health Worker interventions on Medicaid enrollees with diabetes. A quasi-experimental design was used to test the hypotheses that CHW interventions decreased health care utilization and improved the quality of life of Medicaid enrollees with diabetes from one year before the initiation of the CHW intervention through one year of operation. Subjects of the Medicaid patients who expressed interest in the CHW program were included in the evaluation. The intervention group consisted of those who had 5 or more CHW contacts, and the non-intervention group were those who expressed interest but had less than 5 CHW contacts. After completing a minimum of 40 hours of training, CHWs initiated contacts with patients, alternating phone calls and home visits. The intervention included: linking patients with appropriate health care providers, providing social support to patients, monitoring patients' self-care behaviors and signs of complications, and helping and monitoring patients physician's appointment keeping. The Maryland Medicaid and CHW databases were used for analyses. The outcome measures were quality of life (MOS SF-36 questionnaire) at baseline and six month follow-up, number of emergency room visits, number of hospitalizations, days of hospitalization stay, Medicaid health service reimbursements and consistency of diabetic therapy from one year before to one year after the intervention was initiated. Paired comparison t-tests were used to test for differences in the before and after measures. Multiple regression and analysis of covariance (ANCOVA) were used to assess the main effects of covariables (such as age, sex, diagnosis), independent variable (such as number of CHW contacts) and their interactions after adjustment for covariates (such as pre-intervention measures of study variables). Of the 543 respondents, 184 diabetic patients completed the MOS SF-36 questionnaire at baseline and about half (N = 95) completed it at six months follow-up. Of the 543 respondents, only 182 were able to be matched to the Medicaid database after applying study exclusion criteria. The results showed that CHW interventions improved patients' quality of life in six of eight dimensions from 1 to 14%, even though this patient population had much lower baseline scores when compared to those reported in other published studies. In analyzing health care utilization, the intervention group had decreased emergency room visits (49% less for in-patient emergency room visits), decreased hospitalizations, decreased days per hospitalization and reduced Medicaid health service expenditures. The non-intervention group had increases on each of these measures. These data strongly suggest that CHW interventions were effective in reducing numbers of emergency room visit and hospitalization and length of hospitalization for Medicaid enrollees with diabetes. Limitations of the study include selection bias, relatively small sample size and short period of evaluation. However, this study provides very encouraging information about the effectiveness of Community Health Workers, and should serve as a model for outcome research in program evaluation.
    • The sense of coherence factor as a predictor of pharmacy school grade point average

      Harris, Donnell Lynnard; Fedder, Donald O. (1997)
      The purpose of this study was to examine the degree of association between the Sense of Coherence Factor (SOC) and first and second semester grade point average (GPAs) for pharmacy students. In this study an attempt was made to determine if the SOC factor would increase the predictive power of pre-pharmacy GPA and Pharmacy College Admission Test (PCAT) scores, two traditional variables that pharmacy schools use as criteria for admittance. The theoretical framework for the study was based on Aaron Antonovsky's model of a salutogenic orientation to complete physical, emotional and mental health and well being. One's orientation to health is related to one's ability to handle the stressor experiences of life that affect health status outcome. Eight schools, chosen from the eight districts of the National Association of Boards of Pharmacy (NABP), participated in the study. The Sense of Coherence Questionnaire, which consisted of twenty nine likert scaled questions and a demographic sheet, was administered to the students. At the end of the school year, pre-pharmacy GPA, PCAT scores, first and second semester grade point averages were obtained from school officials. There were 288 Caucasians, 71 Asians, 66 African-Americans, 16 Hispanics, 10 Other Blacks, 6 Native Americans and 6 Others in the study. Data were analyzed using multiple regression, frequency distributions, Pearson Product Moment Correlation and Chi Square. Results indicated that for the total sample of pharmacy students, the SOC factor is positively correlated with first and second semester pharmacy school GPA. The correlation is weak, but statistically significant. For the total sample, OC did increase the predictive power of pre-pharmacy GPA and PCAT. For the three major ethnic groups in the study, Caucasians, Asians and African-Americans, there were statistically significant differences in the regression equations and many of the demographic variables. The findings of this study suggest that further research is needed to validate the SOC factor as a predictor of pharmacy school GPA. Further research might include administering the Sense of Coherence to an applicant pool to gain a better understanding of the students applying to pharmacy school, i.e., comparing traditional admission criteria with SOC factor.
    • Testing a culturally consistent behavioral outcomes strategy for cardiovascular disease risk reduction and prevention in low-income African-American women

      Nichols, Gloria June; Fedder, Donald O. (1995)
      This study was designed to add to knowledge in the field of epidemiology and the social behavioral sciences. It is based on the theoretical precepts that there are sociocultural and demographic differences in obesity in African American women, apart from genetic predisposition, that account for excess prevalence. The literature shows that African American women have multiple problems that may contribute to this, including: limited income, mixed beliefs about weight control, multiple health problems, and high preferences for high fat, high sodium, low fiber diets. Forty-one African American Women, 22 volunteer Community Health Workers and 19 volunteers from the University of Maryland at Baltimore secretarial staff were stratified and randomized to an intervention and control group for a twelve week clinical trial of a behavioral intervention designed to decrease consumption of dietary fat as a percentage of total calories, and to increase physical activity levels. The twelve weekly sessions were structured to include both individualized and group interactive teacher-trainer meetings consisting of health education, skills development, demonstrations, recommendations for healthy outcomes, tracking clinical measurements, and facilitated discussions on the concepts of depression, stress, and general well being. Validated instruments were used to collect the outcome measures. The intervention group showed significant improvements over the control group in the reduction of saturated fat, total fat and cholesterol, total body fat, percent of body fat, an increase in lean body mass, a decrease in BMI, and a reduction in the risk factors of diastolic and systolic blood pressures and fasting total cholesterol. There were no significant changes in fasting blood glucose, compared to the control group. Physical activity levels increased in the categories of moderate, hard and very hard activities significantly different for the experimental group as compared to control group. Inference from this study confirm that lack of adherence to diet and weight control and adequate levels of physical activity are rooted in cultural and societal patterns that determine the group's perceptions and beliefs about health and illness as they relate to proper diet and nutrition and adequate physical activity. The study concludes that given a lack of normative values for maintaining a healthy weight, a culturally consistent behavioral change strategy can provide positive social and professional support to initiate, enable, and reinforce changes in behavior in a high risk population.