A Community Health Worker Intervention for Diabetes Self-Management Among the Tz'utujil Maya of Guatemala

Health Promot Pract. 2015 Jul;16(4):601-8. doi: 10.1177/1524839914557033. Epub 2014 Nov 5.


Despite the high prevalence of diabetes in rural Guatemala, there is little education in diabetes self-management, particularly among the indigenous population. To address this need, a culturally relevant education intervention for diabetic patients was developed and implemented in two rural communities in Guatemala. An evaluative research project was designed to investigate if the structured, community-led diabetes self-management intervention improved selected health outcomes for participants. A one-group, pretest-posttest design was used to evaluate the effectiveness of the educational intervention by comparing measures of health, knowledge, and behavior in patients pre- and postintervention. A survey instrument assessed health beliefs and practices and hemoglobin A1c (HgA1c) measured blood glucose levels at baseline and 4 months post initiation of intervention (n = 52). There was a significant decrease (1.2%) in the main outcome measure, mean HgA1c from baseline (10.1%) and follow-up (8.9%; p = .001). Other survey findings were not statistically significant. This study illustrates that a culturally specific, diabetes self-management program led by community health workers may reduce HgA1c levels in rural populations of Guatemala. However, as a random sample was not feasible for this study, this finding should be interpreted with caution. Limitations unique to the setting and patient population are discussed in this article.

Keywords: chronic disease; diabetes; health education; health promotion; international/cross-cultural health.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Community Health Services / methods*
  • Community Health Workers / education
  • Community-Institutional Relations
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / psychology*
  • Female
  • Georgia
  • Glycated Hemoglobin / analysis
  • Guatemala
  • Health Education
  • Health Knowledge, Attitudes, Practice*
  • Health Personnel
  • Health Promotion / methods*
  • Health Surveys
  • Hemoglobin A / analysis
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Indians, Central American / psychology*
  • Male
  • Metformin / therapeutic use
  • Rural Population
  • Schools, Medical
  • Self Care


  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Hemoglobin A
  • Metformin