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Massachusetts League of Community Health Centers
Underserved minorities


A community health worker, formally trained in diabetes management, is added to the health care team.

Project leaders in partnership with the Central Massachusetts Area Health Education Center adapted a nationally-recognized community health worker training program to include information on how to assist patients in their efforts to manage diabetes and improve glycemic control. Each community health worker receives 45 hours of classroom and field-based training and is assigned to care for patients with diabetes at his or her community health center. In addition to the initial training, periodic in-service conference calls are held and three additional training workshops are offered.

Patients meet with the community health worker for 30 minutes before each scheduled appointment or speak with them in advance by phone. The primary objective of each meeting is to help the patient develop a self-management goal. During each meeting an encounter form is completed to help guide the discussion and document what topics were addressed.


Community health workers can serve as valuable bridges between the treatment regimen medical professionals prescribe
and the day-to-day realities of patients’ lives. Recruited directly from the patient populations they serve community health workers often share similar ethnic and cultural backgrounds, language, traditions, and perspectives. Additionally, they have more time to spend with patients than primary care providers and can help patients navigate the complex health care system.

Often training programs for community health workers are brief and lack comprehensiveness. Formal training gives graduates of the program the knowledge and skills to improve patient outcomes and provides advancement opportunities for existing staff members interested in case management positions.

Keeping in mind the cultural, linguistic and health literacy diversity of the trainees, the improved training curriculum focuses on building skills related to service coordination, interpersonal and organizational relations, communication and interviewing, advocacy, leadership, and cultural awareness. A more general introduction to several health topics was replaced with sessions on the Chronic Care Model, managing chronic disease, and diabetes management.

Summary Results

Adding a community health worker, formally trained in diabetes management, to the care team failed to improve clinical outcomes. However, it did result in a significant increase in likelihood of recording a self-management goal (82% vs 17% for controls), and an increase in the number of days within the last week that patients have checked their feet (3.7 pre vs 4.8 post-intervention).


Community Health Worker Encounter Forms: A Tool to Guide and Document Patient Visits and Worker Performance
American Journal of Public Health. 2012 Jul; 102 (7):e70-75.
Full Article (subscription may be required)

Community Health Workers Assisting Patients With Diabetes in Self-management
Journal of Ambulatory Care Management. 2012; 35(1): 15–26.
Full Article
(subscription may be required)

Developing Community Health Worker Diabetes Training
Health Education Research. Online 2011.
Full Article (subscription may be required)

Principal Inverstigators

  • Joan Pernice, MS, BS
  • J. Lee Hargraves, PhD., MS, BS