Adverse Social Determinants of Health in Children with Newly Diagnosed Type 1 Diabetes: A Potential Role for Community Health Workers

Abstract

Objective. There are significant socioeconomic and racial disparities in glycemic control among children with type 1 diabetes (T1D). Community health workers (CHWs) have been shown to improve outcomes in marginalized, high-risk populations. The purpose of this qualitative study was to describe the prevalence and the impact of adverse social determinants of health (SDOH) on diabetes care soon after a diagnosis of pediatric T1D, and investigate the potential supportive role of a CHW. Research Design and Methods. Caregivers of youth <17-year old, with new onset T1D, and government insurance at the time of diagnosis were enrolled. Baseline demographic and SDOH questionnaires were administered at the time of enrollment. Semistructured interviews were performed at 3 months after diagnosis to explore the effect of SDOH on diabetes care and the impact of a CHW. Results. Seventeen caregivers were enrolled, 10 were randomly assigned to a CHW. Two-thirds of caregivers identified at least one SDOH need at enrollment; 35% of caregivers identified two SDOH needs. Interviews revealed that the two major themes identified as barriers to diabetes care were caregivers’ employment and financial issues. Social support was identified as a facilitator. The transition from hospital to home after the diagnosis of T1D was improved for families working with a CHW, and the CHW was identified as a strong source of support. Conclusions. There is a high prevalence of adverse SDOH in families from lower socioeconomic status at the time of diagnosis of pediatric T1D. These SDOH have a significant impact on families’ abilities to care for their children. Preliminary data suggest that CHWs can be a facilitator to the diabetes care. This trial is registered with NCT04238949.