Study investigates impact of community health workers in helping people with type 2 diabetes

Rafael Pérez-Escamilla, professor of public health (social & behavioral sciences) at the Yale School of Public Health, has been awarded a $400,000 grant from the American Heart Association to study how a novel produce-prescription program might improve the health of Hispanic people in Hartford, Connecticut, with type 2 diabetes.

The study summary, as presented by Pérez-Escamilla, states that many people with type 2 diabetes aren’t able to eat enough fresh fruits and vegetables because they’re expensive or not available in their neighborhoods. The problem is particularly acute in high-poverty urban areas like Hartford, which has a large Hispanic population. To counter this problem, some health centers have begun prescribing free produce to their patients.

The goal of this study is to find out whether in addition to the prescription, providing patients with individual support by community health workers improves their health.

“Type 2 diabetes causes an enormous amount of human suffering,” said Pérez-Escamilla, director of YSPH’s Office of Public Health Practice (OPHP). “When it’s not properly self-managed, it’s a condition that negatively and substantially affects all blood vessels, increasing the risk of cardiovascular disease, limb amputations, kidney failure and blindness, among other things.”

YSPH is leading the research project; partners include the Yale-Griffin Prevention Research Center, the Hispanic Health Council, Hartford Hospital, Griffin Health, Emory University, and Wholesome Wave.

During the six-month study, 116 patients from Hartford Hospital who have diabetes, and are Hispanic and on Medicaid or eligible for Medicaid, will be prescribed a store purchase card to buy fresh fruits and vegetables. The patients will receive $40 on their cards each month for six months. They will also be invited to attend nutrition classes at the Hispanic Health Council.

Additionally, half of the patients will also receive support from a community health worker at the Hispanic Health Council. This person will call patients often to see if they are having any problems in the program, and can assist patients in using their prescription, such as helping them to get to the store or replacing a lost card.

At the end of the program, the researchers will compare prescription redemption and blood sugar outcomes among people who received health worker support and those who did not, to see if the community health worker model is effective. If it is, Pérez-Escamilla hopes that health centers around the country will offer the intervention to their patients – and that one day, it could also be part of government insurance coverage.

Currently, type 2 diabetes represents a huge financial cost to societies, he said. The American Diabetes Association estimates the cost of diagnosed diabetes in the U.S. in 2022 was $412.9 billion – $306.6 billion in direct medical costs and $106.3 billion in indirect costs.

While type 2 diabetes is preventable through the promotion of a healthy lifestyle, the problem is exacerbated among minority communities, Pérez-Escamilla said, because of inequities in the health care system, lack of access to healthy foods, and chronic exposure to toxic stress.

“Unfortunately, because of social injustice, type 2 diabetes hits particularly hard among low-income people, especially those belonging to minoritized groups, including people who self-identify as Hispanics, African Americans, and Native Americans/Alaskan Natives,” he said. “These individuals have very limited access, if any, to health care, healthy diets, opportunities for leisure-time physical activity, and protection against toxic stress, including frequent experiences of racism and discrimination.”

Pérez-Escamilla has a long-standing relationship with the Hispanic Health Council and said his main inspiration for this project was “the amazing Hispanic communities in Hartford.” He has three decades of community-engaged research and program evaluation experience. A main thrust of his research focuses on addressing widespread household food insecurity and poor physical and mental health in marginalized communities.

Pérez-Escamilla said he was grateful to the American Heart Association “for giving us the opportunity to continue promoting improved food security and health outcomes among our low-income and highly marginalized Hispanic communities in Hartford, using a ‘Food Is Medicine’ approach.”