Back
Community health worker (CHW) interventions have been an important strategy to reduce health disparities within the Latinx community. CHWs are lay, non-medical individuals, who are trusted and provide social support, care coordination, and advocacy for communities. A recently published patient-level randomized CHW intervention addressed unmet social needs and, as a result, reduced hospitalizations and costs. Although there has been acknowledgement that CHWs could play an important role in reducing kidney health disparities, there are few studies examining the effectiveness of CHW interventions for individuals with kidney disease. Our objective was to assess the feasibility, acceptability, and effectiveness of a CHW intervention for Latinx individuals with kidney failure.
The study design was a two-arm, multi-site, unblinded, patient-level randomized controlled trial that enrolled between October 2020 and April 2022 from 5 urban dialysis centers in Colorado, USA. Eligible participants included Latinx individuals who were ≥ 18 years, had kidney failure, and received hemodialysis for ≥ 3 months. A CHW contacted participants to gauge interest and consent. The two arms included a CHW arm, in which a CHW provided support during individual visits over a 3-month period or a control (standard care) arm. CHWs were trained in motivational interviewing and provided support during individual visits for intervention participants. CHWs (1) assessed social factors and provided resources; (2) used motivational interviewing to support goal directed decision-making; (3) supported language and culturally concordant kidney education; and (4) attended key clinical visits and provided language interpretation. We assessed change in patient activation using the Patient Activation Measure (PAM): level 1 (disengaged), level 2 (aware but struggling), level 3 (taking action), level 4 (maintaining behaviors).
We achieved a recruitment rate of 80% and 100% retention (Figure 1). Of 140 Latinx participants, 68 (48.6%) were female and participated in our study. The mean (SD) age was 59 ±13, the majority lived in poverty and reported a low-level education and health literacy, and a third report food and housing insecurity (Table 1). Sixty eight were randomized to intervention and 71 to control. Intervention participants received a mean (SD) of 8 ± 3 visits with most in-person at the dialysis center (79%) and the mean (SD) visit duration was 62 ± 31 minutes. The intervention period was a mean (SD) of 137 ± 37 days. Patient activation score was assessed at baseline: 25 (18%) had level 1 (disengaged), 49 (35.2%) had level 2 (aware but struggling), 33 (23.2%) had level 3 (taking action), and 32 (23%) had level 4 (maintaining behaviors). The change in PAM score from baseline to follow-up increased for the intervention group, mean (SD) of 2.6 ± 13.3, and decreased for the
control group, mean (SD) -3.0 ± 13.7; p=0.0051; Cohen’s d=0.41.
A CHW intervention improved patient activation among Latinx individuals with kidney failure receiving in-center hemodialysis who often have a decrease in patient activation over time. This is one of the first studies to demonstrate that CHW support increases person-centered outcomes among individuals with kidney failure.