A community-based diabetes group pilot incorporating a community health worker and photovoice methodology in an urban primary care practice

Abstract

Objective: The purpose of this study is to evaluate a three-month, community-based, diabetes self-management pilot intervention using photovoice, a community health worker (CHW), and group education sessions in an urban, African-American safety-net population, a group disproportionately affected by diabetes, in order to identify promising diabetes management approaches. Design: We invited patients with poorly-controlled diabetes from diabetes “hotspots” in Boston, located in African-American communities, to participate in six group sessions at a public library. Sessions included photovoice, a methodology whereby patients use photography and written narratives to facilitate deeper reflection about a specified issue. We designed three photovoice missions with different prompts about participants’ day-to-day lives related to diabetes. After each mission, a CHW facilitated discussions of participants’ experiences, coordinated educational presentations (e.g, dentistry), and connected participants to services. We created an age- and sex-matched control group to compare A1C levels at baseline and post-intervention. We coded transcripts of sessions for themes of barriers to and motivators of diabetes control, using grounded theory. Results: Hemoglobin A1C levels did not improve in the intervention group relative to the control group. Barriers included non-adherence to diabetes self-management behaviors, lack of dietary knowledge, and frustration and fatigue towards diabetes self-management. Participants attributed frustration and fatigue to the chronic nature of diabetes and lack of improvement in disease control markers. Conclusion: The combination of lack of adherence and frustration and fatigue is concerning for the development of burnout in the diabetic patient population. Interventions to build resilience in these individuals and communities should be explored.

Keywords

• diabetes
• chronic disease
• photovoice
• community health workers