Community Health Workers Help Make Diabetes Support Stick

Community Health Workers Help Make Diabetes Support Stick

Diabetes is shaped by more than numbers on a lab report. Daily realities like food access, transportation and other challenges can affect whether people can follow through on healthy changes over time. For many families, small changes start with practical support and someone to help them keep going.
That is where community health workers come in. Community health workers, often called CHWs, are trusted community members who help people understand health information, connect to resources and solve problems that can get in the way of managing diabetes or prediabetes. 

Diabetes Free SC (DFSC) is an initiative of the BlueCross BlueShield of South Carolina Foundation. DFSC supports partner-led efforts that reduce the impact of diabetes across the state. One example is the way CHWs add support in federally qualified health centers and in programs that make healthy eating more practical, including VeggieRx.

For many, healthier habits start with a good intention. Then real life shows up. A CHW can help people take the next step and keep going, especially when barriers feel overwhelming.

How Community Health Workers Help 

CHWs are not clinicians, but they are part of patient care teams. They help people understand diabetes, follow a plan and connect to services that support health outside a medical visit.

CHWs also help address needs that affect health outcomes but exist outside the clinical scope, including food security, transportation and housing.
In practice, CHW support may include:

• Explaining health information in plain language
• Helping patients connect to community resources
• Checking in over time to reinforce goals and help patients stay engaged

This role matters because diabetes can require ongoing problem-solving, not a one-time conversation.

VeggieRx: Fresh Food, Practical Support 

A nutritious diet is essential for preventing and managing diabetes and prediabetes. But access to fresh produce is not always simple. VeggieRx, a program of FoodShare South Carolina, works with health care professionals to provide fruit and vegetable prescriptions to patients with diabetes and prediabetes. Patients receive boxes of fresh produce through FoodShare’s Fresh Food Box program, with enough food for about two weeks of meals. Boxes also include easy-to-prepare recipes and tips for healthy eating. Patients receive 13 boxes over six months.

At some VeggieRx sites, CHWs help patients make the most of what they receive. They talk through nutrition basics, share simple cooking ideas and provide ongoing feedback based on each person’s needs. For many people, that extra support can help turn a box of produce into meals they will actually make and habits they can keep.

“The fresh food boxes from VeggieRx helped me and my family start healthier habits. The CHW who worked with us gave us the tools we needed to better ourselves. I’m more aware of what I’m eating, and my A1C levels have gone down.” — Benita Spann, VeggieRx patient

Support Where People Already Get Care 

Federally qualified health centers, often called FQHCs, serve communities that may face higher health risks and more barriers to services.

In August 2021, DFSC announced a Community Health Worker project as a funded effort to help reduce diabetes and its complications among South Carolinians. The early work focused on building a diabetes prevention and management model within participating FQHCs. This included training for CHWs and supervisors and development of diabetes-focused approaches within health center teams.

The participating health centers included:

• Affinity Health Center
• Beaufort-Jasper-Hampton Comprehensive Health Services
• CareSouth Carolina Inc.
• HopeHealth Inc.
• Tandem Health

This approach reflects how DFSC works statewide. DFSC supports and aligns partners who deliver programs in communities.

What the 2025 Numbers Show

DFSC’s 2025 impact report highlights the reach of VeggieRx and the role CHWs can play alongside it.

In 2025, VeggieRx served about 2,200 patients each month, delivered 3,939 boxes and operated across seven federally qualified health centers. The report also notes improvements that include lowered blood pressure, lowered A1C levels and lowered weight.

These results point to a practical lesson: access can be stronger when it is paired with trusted support that helps people use what they receive in daily life.

What Comes Next 

Diabetes does not have a quick fix. It takes long-term effort across health care and community settings to support prevention and reduce complications. By supporting partner-led programs that meet people where they are, DFSC continues to strengthen statewide efforts to reduce the impact of diabetes in South Carolina.