Community Health Worker-Led Diabetes Care in Underserved Populations: Effect Sizes and Sustainability
DOI:
https://doi.org/10.5281/zenodo.22261266Keywords:
Community health workers, Diabetes disparities, Glycaemic control, Sustainability, Underserved populationsAbstract
Community health workers recruited from the populations they serve have been deployed widely to address disparities in diabetes
outcomes, and the evidence that they improve glycaemic control is reasonably consistent. Meta-analysis of 40 studies including
9,606 participants estimated a reduction in HbA1c of 0.39 percentage points (95% CI 0.31 to 0.48), and a smaller synthesis of six
studies and 1,280 participants reported 0.50 points (0.28 to 0.71) with low heterogeneity and high certainty. Individual
programmes report figures of a similar order. Two features of this literature complicate its translation into policy. Programmes
are short, with a median duration of six months, and few studies follow participants after the intervention ends, so whether the
benefit persists is largely unknown. And the evaluations that examined implementation identified worker retention and programme
sustainability as recurring problems, concluding that community-based programmes can bridge gaps in access without addressing
the structural inequalities that produce them.
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