Role of community health workers in type 2 diabetes mellitus self-management: A scoping review

Background
Globally the number of people with Type 2 diabetes mellitus (T2DM) has risen significantly over the last few decades. Aligned to this is a growing use of community health workers (CHWs) to deliver T2DM self-management support with good clinical outcomes especially in High Income Countries (HIC). Evidence and lessons from these interventions can be useful for Low- and Middle-Income countries (LMICs) such as South Africa that are experiencing a marked increase in T2DM prevalence.
Objectives
This study aimed to examine how CHW have been utilized to support T2DM self-management globally, their preparation for and supervision to perform their functions.
Method
The review was guided by a stepwise approach outlined in the framework for scoping reviews developed by Arksey and O’Malley. Peer reviewed scientific and grey literature was searched using a string of keywords, selecting English full-text articles published between 2000 and 2015. Articles were selected using inclusion criteria, charted and content analyzed.
Results
1008 studies were identified of which 54 full text articles were selected. Most (53) of the selected studies were in HIC and targeted mostly minority populations in low resource settings. CHWs were mostly deployed to provide education, support, and advocacy. Structured curriculum based education was the most frequently reported service provided by CHWs to support T2DM self-management. Support services included informational, emotional, appraisal and instrumental support. Models of CHW care included facility linked nurse-led CHW coordination, facility-linked CHW led coordination and standalone CHW interventions without facility interaction.
Conclusion
CHWs play several roles in T2DM self-management, including structured education, ongoing support and health system advocacy. Preparing and coordinating CHWs for these roles is crucial and needs further research and strengthening.

背景
近数十年来，全球2型糖尿病（Type 2 diabetes mellitus, T2DM）患者人数显著攀升。与此相伴的是，社区健康工作者（Community Health Workers, CHWs）用于提供2型糖尿病自我管理支持的应用愈发广泛，且已在临床结局上取得良好效果，这一现象在高收入国家（High Income Countries, HIC）尤为突出。上述干预措施的相关证据与实践经验，对于正面临2型糖尿病患病率显著上升的南非等中低收入国家（Low- and Middle-Income Countries, LMICs）而言具有重要借鉴价值。

研究目标
本研究旨在梳理全球范围内社区健康工作者被用于支持2型糖尿病自我管理的实践模式，以及社区健康工作者开展相关职能所需的岗前准备与在岗督导情况。

研究方法
本综述遵循Arksey与O’Malley提出的范围综述（scoping reviews）框架所制定的分步研究流程开展工作。通过构建关键词检索策略，检索同行评审科学文献与灰色文献，筛选2000年至2015年间发表的英文全文文献。依据纳入标准完成文献筛选、数据提取与内容分析。

研究结果
本研究共检索到1008项相关研究，最终筛选纳入54篇全文文献。其中53项纳入研究来自高收入国家，研究对象多为资源匮乏环境中的少数群体。社区健康工作者的主要部署方向为提供健康教育、支持服务与权益倡导。其中，基于标准化课程的健康教育是社区健康工作者用于支持2型糖尿病自我管理的最常见服务类型。支持服务涵盖信息支持、情感支持、评估支持与工具性支持四大类别。社区健康工作者的照护模式主要包括三类：依托医疗机构的护士主导的社区健康工作者协调模式、依托医疗机构的社区健康工作者主导协调模式，以及无医疗机构互动的独立社区健康工作者干预模式。

研究结论
社区健康工作者在2型糖尿病自我管理中承担多重角色，包括标准化健康教育、持续支持与卫生系统权益倡导。为社区健康工作者开展职能相关的培训与协调工作至关重要，相关领域仍有待进一步研究与体系完善。