Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


Interdisciplinary Studies

First Advisor

Toms, Forrest


Diabetes is a chronic disease that bears a disproportionate burden among African American populations. The lack of access to affordable, culturally appropriate health care is a key barrier to effective diabetes prevention or disease management for racial/ethnic minority populations. Living in public housing communities, with concentrated poverty, exacerbates the burden of diabetes and reduces access to screening and early detection services to prevent the onset of diabetes. The purpose of the study was to describe the leadership role of lay health advisors, known as Community Health Ambassadors (CHAs), on diabetes-related health behaviors of African Americans living in a public housing authority (PHA) community in one city in Southeastern North Carolina. The research sample included CHAs (n = 17) and the PHA residents (clients; n = 62) participating in the pilot Community Health Ambassador Program (CHAP). A mixed methods research design was used to describe the outreach services provided by CHAs and explore associations between outreach and diabetes-related health behaviors among the clients they served. Analyses included secondary quantitative data and primary qualitative focus group data from CHAs and clients. The results of this one sample design pilot study indicated that it is feasible to implement CHAP in public housing communities. While the study’s findings suggest there is no association between CHA outreach and clients’ health behaviors, the leadership roles of the CHAs are demonstrated. Preliminary data were suggestive, but not significant for key clinical outcomes and health behaviors. From the perspectives of CHAs and their clients, the CHAP was beneficial to them and their community. The study underscores the need for future research to examine the leadership roles of racial/ethnic minorities as partners in community-based programs with a focus on eliminating health disparities.