Pilot Community Health Worker-Based Intervention to Address Social Determinants of Health Among Patients with Diabetes in Ophthalmology.

Abstract

Purpose: Community Health Workers (CHWs) represent a potential strategy in ophthalmology to address adverse social determinants of health (SDoH) and improve vision outcomes. In this study, we explored the feasibility, acceptability, and impact of a structured CHW intervention among patients with diabetes.

Materials and methods: This was a prospective single-center pilot study conducted at the Johns Hopkins Wilmer Eye Institute. Adult participants (≥ 18 years) with diabetes and at least one adverse SDoH participated in the study. The CHW worked with the participant for on average 6 months to address the social barriers identified at screening. At the conclusion of the study, participants completed a follow-up SDoH survey and a semi-structured exit interview.

Results: Out of 45 enrolled participants, 23 completed the study (mean age 56 years, 52% female, and 83% non-Hispanic Black). Many participants (83%) were satisfied with the frequency of the meetings, 87% had a positive experience with the CHW and felt respected and supported (74%) throughout the program. The experience with the broader program was more mixed with 17% reporting it was negative, 22% neutral, and 57% positive. Participants found the program helpful for resource education (65%), emotional support (43%), access to medical services (43%), and self-confidence (57%). Challenges included limited resources available to address certain social needs and language barriers among the Spanish speaking participants. Participants reported high trust in CHW, but there were no significant changes in pre- and post-intervention SDoH surveys (p>0.05).

Conclusion: Integration of CHWs into ophthalmology is feasible and acceptable among patients with diabetes who remained actively engaged over time. High trust in CHW and improvement in resource navigation, health knowledge, and confidence were reported. Our findings support development of CHW integration in ophthalmology as a potential intervention to address barriers to care and improve vision outcomes.