Diabetes Research Programme - DM17

Tools and Practices to Reduce CVD and Complications in the Diabetic Population in Mexico

Project location: Mexico

Funding organisation(s)

• National Heart, Lung, and Blood Institute, USA (NHLBI)
• National Institutes of Health, USA (NIH)

Primary research aim

This 5-year research project will focus on the prevention of cardiovascular disease (CVD) and its complications among adults with diabetes who use public health services in Sonora, Mexico. One major component of the study will assess the effectiveness of an adapted evidence-based community health worker intervention, Meta Salud Diabetes, a 13-week intervention aimed at reducing behavioral and clinical risk for cardiovascular disease among adults with diabetes. The second component is an implementation study that will consist of systematic engagement of local, state and national decision makers essential to scale up and sustain the intervention into the standard package of services offered by government-run health centers in Sonora and other Mexican states.

Research objectives and methodology

For the first component of the study we will conduct a cluster-randomized trial among adult patients with diabetes sampled from 20 Secretaría de Salud (Secretary of Health)-operated health centers in Sonora. Community health workers and other personnel at each of ten health centers randomized to the intervention condition will be trained in the adapted CVD prevention curriculum. The health center personnel will then enroll 20 participants with diabetes at each site into the 13-week intervention. Clinical risk factors (i.e., BMI, blood pressure, lipids, blood sugar), psychosocial (e.g., knowledge, attitudes, and beliefs) and behavioral (e.g., smoking, healthy eating) risk factors for cardiovascular disease will be assessed via tests and a survey during the first of the 13 weekly educational sessions. We will then assess changes that occur at three months (immediately after the intervention) and 12 months. Changes in the intervention sites will be compared to changes over the same time period among adult patients with diabetes in each of ten health centers randomized to the control condition. For the second component of the study, extensive qualitative and descriptive data will be collected on the facilitators and barriers to adopt and integrate community health worker chronic disease interventions in Sonoran health centers and throughout Mexico.

Project contact: Cecilia Rosales - crosales@email.arizona.edu

Investigators

• Cecilia Rosales, University of Arizona, USA
• Elsa Cornejo, El Colegio de Sonora, Mexico
• Scott Carvajal, University of Arizona, USA
• Maia Ingram, University of Arizona, USA
• Jill Guernsey de Zapien, University of Arizona, USA
• Samantha Sabo, University of Arizona, USA
• Melanie Bell, University of Arizona, USA
• María del Carmen Castro, El Colegio de Sonora, Mexico
• Catalina Denman, El Colegio de Sonora, Mexico

Publications

1. Denman CA, Rosales C, Cornejo E, Bell ML, Munguía D, Zepeda T, et al. Evaluation of the Community-Based Chronic Disease Prevention Program Meta Salud in Northern Mexico, 2011–2012. Prev Chronic Dis 2014;11:140218. DOI: http://dx.doi.org/10.5888/pcd11.140218.
2. Denman CA, Bell ML, Cornejo E, de Zapien JG, Carvajal S, Rosales C. Changes in Health Behaviors and Self-Rated Health of Participants in Meta Salud: A Primary Prevention Intervention of NCD in Mexico. Global Heart 2015;10(1):55-61. DOI: http://dx.doi.org/10.1016/j.gheart.2014.12.007.