The EMPATHy Toolkit: Helping Diabetes Patients Overcome Barriers to Medication Adherence

Low income, Mexican American patients with diabetes exhibit high rates of medication
nonadherence, which results in poor blood sugar control and serious complications, and often
have difficulty communicating their concerns about the medication regimen to physicians.
Interventions led by community health workers (CHWs), non-professional community members who
are trained to work with patients to improve engagement and communication during the medical
visit, have had mixed success in improving outcomes. Although CHWs possess excellent
cultural competency and are very effective at establishing rapport with patients, they often
lack a sophisticated understanding of all the potential challenges that can come with
following a regimen. The primary objective of this project is to develop and pilot test a
prototype software toolkit called "EMPATHy" that a CHW can administer to help patients
identify and articulate the most important barriers to adherence that they face.

The EMPATHy toolkit will be piloted in an ongoing intervention (Coached Care) in which CHWs
are trained to be "Coaches" to meet with patients before the medical visit, and help them
prepare a list of important questions for the doctor. The Lead Researcher (Billimek) is a
co-director of this intervention program at UCI's Ambulatory Clinics, including the Family
Health Center in Santa Ana ,with a highly vulnerable population—low income Mexican American
patients with diabetes and a history of nonadherence. A CHW will be trained to use two
commercially available software programs configured by the PI to deliver the intervention
materials. Patients participating in Coached Care (which is a clinic- based intervention,
not a research protocol) will be recruited to (1) complete a Coached Care intervention
session that has been modified to incorporate the EMPATHy Toolkit, (2) answer questions
about barriers to medication adherence and the feasibility/usability of the software (3)
allow the research team to abstract data on the medication regimen and diabetes outcomes
(hemoglobin A1c, LDL cholesterol, etc) from the patient's medical record.

Inclusion Criteria:

- Patients will be recruited from the University of California Irvine Federally
Qualified Health Center family medicine clinic sites in Santa Ana and Anaheim with
the following inclusion criteria:

1. age 18 and older;

2. have poorly controlled type 2 diabetes (as indicated by HbA1c>7.5%, LDL
cholesterol >100 mg/dl or systolic blood pressure > 140),

3. be of Hispanic ethnicity,

4. speak English or Spanish.

These data are available to the research team in an automated report emailed to the lead
researcher every week in his role as coordinator of the routine care Coaching program.
This report includes a list of upcoming appointments for patients who meet these inclusion
criteria.