Social Network Analysis to Identify Community Health Workers
Condition: Type2 Diabetes
Study type: Interventional

Summary: 
      The objective of this study is to recruit influential community members using Snowball
      Sampling Methods. Community members identified through social network analysis as influential
      and well-connected will be trained as community health workers (CHW) using the Diabetes
      Empowerment Education Program (DEEP). These CHW will be used in a future trial to educate
      other members of the community.
    

Detailed description: 
      The proposed research employs the Integrated Behavior Model (IBM) to address fundamental
      drivers of behavior for older rural-dwelling adults with type-two diabetes mellitus (T2DM) in
      the context of their social network. Social network analysis (SNA) is characterized as the
      examination and interpretation of relational connections. This approach can be used to map
      social networks and understand relationships between individuals as it pertains to social
      support. Snowball recruitment methods will be used to recruit participants in this study. In
      Aim 1, individuals who are connected to several individuals within their community and have
      the capacity to influence norms that hinder T2DM self-care will be identified. Ten
      individuals who have received medical care from the Center of Excellence in Rural Health
      (CERH) within the past 12 months will be identified. Initial recruitment will be conducted by
      a community liaison in Leslie County. This core group of 10 "seeds" will be used to conduct
      the first wave of interviews. Since the aim of social network analysis is to understand a
      community by mapping the relationships that connect them as a network, each seed will be
      asked to identify 3 persons believed to be influential in their community. Those who are
      identified in wave 1 will also be asked to identify 3 people each from their community who
      are also respected as leaders and can be trusted to provide health-related information to
      community members. This process will continue for 4 waves of recruitment (N˜200).

      Participants will be asked to provide demographic information including age, sex,
      race/ethnicity, education, employment status, contact information (address, telephone number,
      email). An interview guide will be adapted from a previously published intervention assessing
      social networks and health behavior informed by preliminary data and the expert opinion of my
      team of mentors and collaborators. The interviews will begin with two broad general questions
      asking "who" is included in their social network and "how" members of the social network
      provide social support; using open-ended questions to elicit maximal information with minimal
      bias. Interview questions will explore the following domains: size and structure of social
      network; resources available through social network; beliefs of those in social network
      regarding general healthy behavior; knowledge of available healthy lifestyle choices; and
      perceived acceptable healthy behaviors (social norms). Data will be collected from CHWs pre-
      and post-training to assess the following: T2DM knowledge: Diabetes Knowledge Questionnaire
      (DKQ) a 24-item survey that has a reliability coefficient of 0.78 and showed sensitivity to a
      T2DM knowledge intervention. Health literacy: Newest Vital Sign (NVS) is a 6-item survey to
      assess health literacy comprehension and numeracy. Means and paired t-tests will be conducted
      to determine if health literacy and T2DM knowledge improved in each CHW during the DEEP
      training.
    

Intervention name(s): Diabetes Empowerment Education Program
Intervention type(s): Other
Intervention description(s): Individuals identified as Community Health Workers will participate in the Diabetes Empowerment Education Program (DEEP™). DEEP, is an education curriculum designed to help people with pre-diabetes, diabetes, relatives and caregivers gain a better understanding of diabetes self-care. Classes last a total of six weeks, providing participants with eight unique learning modules. Health literacy will be assessed before and after participating in DEEP.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Diabetes Empowerment Education Program (DEEP); social network analysis; Integrated Behavioral Model (IBM); rural; community; Appalachia