1. La salud de la gente es un derecho humano. | We believe health care is a basic human right. La salud de la gente es un derecho humano.We believe health care is a basic human right. iDecide/Decido Decision Aid The role of community health workers in the development and delivery of a tailored, interactive, web-based decision aid to low-income Latino and African American adults with poorly controlled type 2 diabetes who received care at a federally qualified health center in Detroit Presenter: Gloria Palmisano APHA 142 nd Annual Meeting & Expo (November 15 - 19, 2014) New Orleans, LA

2. La salud de la gente es un derecho humano. | We believe health care is a basic human right. Disclosures and Funding Sources Gloria Palmisano 2 No relationships to disclose AHRQ R18 DK078558 NIDDK R18 HS019256 NIDDK P30DK092926 (MCDTR)

3. La salud de la gente es un derecho humano. | We believe health care is a basic human right. Background People with diabetes need adequate information about potential benefits, harms, costs, and burdens of medications to make good medication decisions This discussion is too time-consuming for clinic visits Many adults with diabetes lack resources to share in decision making or make an informed decision about their diabetes medications 3

4. La salud de la gente es un derecho humano. | We believe health care is a basic human right. 4 Can CHWs better support diabetes medication decision-making when using a tailored, interactive web- based tool (iDecide) versus using print educational materials?

5. La salud de la gente es un derecho humano. | We believe health care is a basic human right. Goals of the Study Aim 1: Work together to build an interactive, computer tailored diabetes medication decision aid to help people: Assess their treatment goals Identify personal preferences and side-effect concerns Understand options for improving their diabetes care (when appropriate) 5

6. La salud de la gente es un derecho humano. | We believe health care is a basic human right. Goals of the Study (Continued) Aim 2: Compare tool with print guides on participant: –Knowledge of medications –Satisfaction with information –Decisional conflict Aim 3: Look at how the tool affects: –Participant changes in medications –Self-reported medication adherence –Participant beliefs about medication –A1C levels between baseline and follow-up 6 Kate Barr, MPH

7. La salud de la gente es un derecho humano. | We believe health care is a basic human right. Basis for Developing Interactive Web- Based Tool Agency for Healthcare Research and Quality (AHRQ) produced two consumer-focused guides, “Pills for Type 2 Diabetes” and "Premixed Insulin for Type 2 Diabetes“. The presentation of content and delivery of these guides needed to be modified to increase their use and impact among difficult-to-reach populations. 7

8. La salud de la gente es un derecho humano. | We believe health care is a basic human right. Development of iDecide/Decido Decision Aid Community-based participatory research (CBPR) User-centered design (UCD) Community health worker model 8

9. La salud de la gente es un derecho humano. | We believe health care is a basic human right. CHW Role in Development iDecide/Decido Claudia….”I was a part of the entire process”. ”My main role in the development of the tool was to use my experience with the community to ensure that the material was culturally and linguistically appropriate in both English and Spanish”. 9

10. La salud de la gente es un derecho humano. | We believe health care is a basic human right. CHW Role in Development iDecide/Decido Deliana…”to bring my personal knowledge and experiences of working with the Latino community with type 2 diabetes in regards to how they take care of their diabetes, barriers to managing diabetes, and using that knowledge and those experiences to develop this new intervention and how it would work best in our Latino community. Examples of the roles that I played were ensure that the decision aid and intervention protocols were appropriate for the target population. Assisting with the Spanish translation and making sure that the Spanish used reflected the Spanish that was spoken by the majority of our clients. Selecting pictures and animation that again reflected our community. Assisted in the development of protocols and their translation”. 10

11. La salud de la gente es un derecho humano. | We believe health care is a basic human right. Results Design concept Animations Pictographs Issue cards Goal setting Tailoring Additional CHW tools 11

12. La salud de la gente es un derecho humano. | We believe health care is a basic human right. Support Values Physical Activity Confidence Adherence Concerns Lab Values Current Meds 12

13. La salud de la gente es un derecho humano. | We believe health care is a basic human right. 13

14. La salud de la gente es un derecho humano. | We believe health care is a basic human right. Glucose and Insulin Characters 14

15. La salud de la gente es un derecho humano. | We believe health care is a basic human right. Description of iDecide/Decido Intervention CHW delivered intervention to improve satisfaction with and knowledge of diabetes medications 2 arms (n=188) Control group: reviews the static, paper AHRQ patient guide with a CHW Intervention group: reviews the tailored, web-based program with a CHW 15 Kate Barr, MPH

16. La salud de la gente es un derecho humano. | We believe health care is a basic human right. Results CHW recommendations contributed to tool being culturally and linguistically appropriate and tailored to needs of community Of the 188 participants, 176 completed follow-up Both groups significantly improved across most measures iDecide participants reported greater improvements in satisfaction with medication information (p=.006) and in diabetes distress (p=0.002) compared to print materials group Only iDecide participants had improvements in A1c from baseline (-0.4%, p=0.002) were more likely to maintain or achieve an A1c<=7% (p<0.05) a high level of self-efficacy (p<0.01) a low level of diabetes distress (p<0.01) 16

17. La salud de la gente es un derecho humano. | We believe health care is a basic human right. Conclusion The combination of CBPR and UCD approaches can serve as an effective model for developing web-based interventions that are efficient, easy to use, and utilize the skills and knowledge of community members, while also meeting the needs of the communities being served. Interactive, tailored web-based tools developed in collaboration with CHWs and delivered by CHWs may improve the effectiveness of CHW diabetes decision support and coaching. 17

18. La salud de la gente es un derecho humano. | We believe health care is a basic human right. Animations- Quick Look http://yertle.chcr.med.umich.edu/chcr/documents/iDecide_demo/

19. La salud de la gente es un derecho humano. | We believe health care is a basic human right. Acknowledgements Larry An Mike Anderson Kate Barr Holly Derry Michele Demers Bryce Erwin Angie Fagerlin Leticia Flores Claudia Gutierrez Michele Heisler Vida Henderson Deliana Ilarraza- Montalvo Alex Jeanpierre Liz Lockhart Rebecca Mase Victor Montori Dennis O’Reilly Mike Nowak Bill Newhouse Gloria Palmisano Viji Ramaswami Ken Resnicow Caroline Richardson Ed Saunders Lisa Smith Mike Spencer Cheryl Tannas Melissa Valerio Sandeep Vijan

20. La salud de la gente es un derecho humano. | We believe health care is a basic human right. La salud de la gente es un derecho humano.We believe health care is a basic human right. Thank You Gloria Palmisano gpalmisano@chasscenter.org