To address the health disparity issues faced by the growing Hispanic population in this country, Pfizer Health Solutions (PHS) developed Amigos en Salud (Friends in Health), a comprehensive community health worker (CHW) program that supports adult Hispanics with diabetes and comorbid depression understand their condition, discover ways to sustain positive health behavior change and maintain self-management skills. The Amigos en Salud program was specifically developed to impact many of the key barriers that Hispanic patients experience such as access to care, language and health literacy issues, cultural beliefs, health care provider shortages, and distrust of the health care system.
CHWs, also known as promotores, are lay people who have the knowledge, trust and respect of the community. These individuals have received extensive training to support patients by providing a culturally appropriate education curriculum, empowering them to maintain their own health records, connecting patients and their families to available resources, and working collaboratively with the healthcare team. Educational materials provided to patients include information on diabetes, cardiovascular disease, mental health, and medication management. These materials are based on the Transtheoretical Model (Stages of Change), available in both English and Spanish and at the appropriate literacy level (4th grade reading level). Lifestyle education, such as for healthy eating and physical activity, is introduced to the patient at the appropriate stage of their behavior.
To assess the effectiveness of the program, a randomized controlled research study was conducted by PHS and local investigators at four sites across the country (California, Texas, and Connecticut). Positive results have been demonstrated in participants receiving support from the CHWs for clinical indicators, such as a decrease in A1c, total cholesterol, LDL and body mass index (BMI), as well as impacting behavioral measures including improvements in physical activity, healthy eating, medication adherence, self-monitoring practices, and depression severity scores. In addition, patient satisfaction surveys have shown that patients in the CHW intervention expressed great program satisfaction for several measures, such as the ability to explain information, taking time with patients, and overall services for diabetes education. Program results have been presented at national meetings such as the American Diabetes Association, American Public Health Association, Centers for Disease Control and Prevention Diabetes Translation Conference and American Association of Diabetes Educators and state and local meetings.
The Amigos en Salud program components are available as a turn-key program for community health center implementation. Program components include implementation manual, data collection tools (surveys, depression screening questionnaire), program evaluation tools (satisfaction survey, analytic database), patient education materials, CHW training and clinic implementation materials. The program materials are available, free-of-charge, and available from the Internet.
Based on the observed effectiveness and acceptance within the Hispanic community, the program has been adapted to serve the needs of the African-American population and the general population.
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