East Carolina University EMPOWER Project

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Location: Greenville, North Carolina

A randomized controlled trial among 200 African American female participants compared the effectiveness of using community health workers (CHWs) to deliver a tailored small behavioral changes intervention with ongoing diabetes self-management support (DSMS), to a mail-only control group receiving diabetes self-management education materials.  Women in the intervention group who were not taking insulin experienced statistically significant changes in HbA1c, diastolic blood pressure, body mass index, and weight.  Implementing a CHW-delivered, small changes intervention was most effective with patients in the early stages of diabetes progression.


This project sought to compare the effectiveness between two diabetes interventions aimed at 200 African-American Women living in rural North Carolina. One intervention used Community Health Workers to deliver tailored behavior-change messaging to diabetes patients, while the other featured similar information mailed to participants, but was not tailored to individual patients.


The EMPOWER Diabetes program featured a small changes approach to diabetes self-management education with topics delivered through face-to-face or via telephone visits from community health workers that included:

  • Goal setting
  • Nutrition monitoring
  • Physical activity
  • Self-talk
  • Problem solving
  • Support for accessing community resources
  • Cognitive behavioral therapy

A control group received packets mailed to them that featured similar information.


Patients that were not using insulin experienced greater improvement to weight, body mass index, A1C, and diastolic blood pressure than patients who were using insulin. This intervention was most effective with patients who were at the early stages of the progression of diabetes and may be particularly useful for addressing lifestyle behaviors after initial diagnosis.