Effectiveness of Peer-Trained Community Health Worker Intervention on Obesity Management in Chinese Adults Living in Informal Houses: A 3-Months Preliminary Investigation

OBJECTIVES: This study aims to investigate the feasibility, and three-month effectiveness of weight management in informally-housed populations using habit-based interventions provided by trained peers.

METHODS: Community health workers (CHWs) are personals who provide health screening and care without formal medical education. Services provided by CHWs are more accessible and culturally-sensible to usual care for their lower cost and higher availability in low-income areas. In an open-labelled, three-arm, parallel cluster randomized controlled trial conducted in inadequately housed population in Hong Kong (HK), we evaluated the impacts on obesity prognosis using CHW intervention in comparing to nursing/dietetics care in Chinese adults (aged 18 year-old or above). Administrative data (including number of sessions conducted, loss-to-follow-up rates etc.) of the trial was reported for feasibility assessment. Anthropometric measurements such as waist circumference (WC) and body mass index (BMI) were used to measure obesity prognosis. Multivariate mixed effect models, using family cluster as fixed effect term, were used to evaluate effectiveness of CHWs intervention.

RESULTS: This preliminary investigation included 59 families (62 obese individuals, mean age [SD] = 48.97 [11.543], 80.6% female) between 25th June 2023 and 14th March 2024, recruited through a primary screening programme. Most of the families (90.9%) earn less than HKD 24999 a month, compared to 49.8% of the general population in HK. The median cluster size was 1 (mean size is 1.051) and ICC was 0.309, and 0.339 for BMI reduction and waist circumference reduction, with a loss-to-follow-up rates of 1.6%. During the period, there were 744 follow-up sessions being conducted. Regression showed that CHWs intervention could reduce 1.334 cm in waist circumference (95% CI [-0.478, 3.146]) and reduce 0.486 kg/m2 in BMI (95% CI [0.089, 0.884]) in an interim reporting of three months.

CONCLUSIONS: CHWs intervention is a feasible and effective healthcare intervention with Chinese, housing vulnerable adults living in HK.