University of California-Irvine
Orange County
Diabetes
Mexican and Vietnamese-Americans

Project

Community-based diabetes coaches are incorporated into the care team.

Diabetes coaches, who themselves have type 2 diabetes, are recruited directly from the local community and trained to work one-on-one with patients who are identified using an existing electronic diabetes registry. The coaches share language and sociodemographic characteristics with the patients and have the ability to serve as “cultural brokers” for what may otherwise be a hard-to-reach population within the clinics.

The coach-patient interaction occurs 20 minutes before regularly scheduled medical appointments, in a private area of the doctor’s office. During that encounter, the diabetes coach addresses self-efficacy, social and cultural barriers to care, lifestyle changes and medication adherence. Using the patient’s personal medical information, obtained directly from the patient and the medical record, the coach tailors the meeting to his or her individual needs. After a patient’s visit with the doctor, coaches debrief patients and help them understand their treatment plan. Coaches also follow up with phone calls two weeks after the first doctor’s visit, and one week prior to subsequent visits, which usually occur every three months.

Rationale

Communication barriers between patients with limited English proficiency and their providers can lead to higher complication rates and poor health outcomes for patients, especially for those who must manage chronic disease. Effective patient-provider communication may result in better health outcomes and help reduce health disparities.

Through culturally appropriate, personalized education, coaches can help patients build information seeking and communication skills that can improve patient-provider communication. The fact that the coaches have type 2 diabetes, are from the same communities, and speak the same languages as the patients they coach creates a peer relationship that may help the patients be more open to the information offered in the coaching session.

The intervention’s potential for success also relies on the timing of the coaching. The coaching that occurs immediately before the patient’s visit with the doctor may encourage better doctor-patient communication inside the doctor’s office.

Summary Results

The introduction of community-based diabetes coaches into care teams for Latino patients did not significantly decrease their HbA1c levels. The effect of the intervention on Vietnamese patients could not be assessed due to insufficient enrollment.

Publications

Understanding Disparities in Lipid Management Among Patients with Type 2 Diabetes: Gender Differences in Medication Nonadherence after Treatment Intensification
Women’s Health Issues. 2015;25(1):6-12. Published online 2014 Nov 22.
Full Article (subscription may be required)

Complementary and Alternative Medicine (CAM) Use among Non-Hispanic White, Mexican American, and Vietnamese American Patients with Type 2 Diabetes
Journal for the Healthcare of the Poor and Underserved. 2014;25(4):1941-1955.
Full Article (subscription may be required)

Reducing Racial/Ethnic Disparities in Diabetes: The Coached Care (R2D2C2) Project
Journal of General Internal Medicine. 2013;28(10):1340-1349. Published online 2013 May 4.
Full Article 

Patient Complexity and Risk Factor Control Among Multi-morbid Patients with Type 2 Diabetes: Results from the R2D2C2 Study
Medical Care. 2013;51(2):180-185.
Full Article 

The Effects of Financial Pressures on Adherence and Glucose Control Among Racial/Ethnically Diverse Patients with Diabetes
Journal of General Internal Medicine. 2012;27(4):432-437.
Full Article 

Support and Influence in the Context of Diabetes Management: Do Racial/Ethnic Differences Exist?
The Journal of Health Psychology. 2011;16(5):711-721. Published online 2011 Mar 28.
Full Article 

Underdiagnosed and Undertreated Depression among Racially/Ethnically Diverse Patients with Type 2 Diabetes
Diabetes Care. 2011;34(3):598-600. Published online 2011 Jan 27.
Full Article 

Marital status and gender differences in managing a chronic illness: The function of health-related social control
Social Science & Medicine. 2010;71(10):1831-1838.
Full Article (subscription may be required) 

Who Can Respond to Treatment? Identifying Patient Characteristics Related to Heterogeneity of Treatment Effects
Medical Care. 2010;48(6 Suppl):S9-S16.
Full Article (subscription may be required) 

Additional Resources

• Project Website Coached Care for Diabetes Program (CCDP)

Principal Investigator

• Quyen Ngo-Metzger, MD, MPH