Language

English

Publication Date

1-1-2025

Journal

Journal of Primary Care & Community Health

DOI

10.1177/21501319251379740

PMID

41014069

PMCID

PMC12476492

PubMedCentral® Posted Date

9-27-2025

PubMedCentral® Full Text Version

Post-print

Abstract

including among control groups. Increased access to care and heightened health awareness during trial enrollment could lead to altered behaviors, a phenomenon known as the Hawthorne effect, which may obscure true intervention impacts; however, this effect remains poorly studied in low-income environments.

Aim: To conduct a secondary exploratory analysis of healthcare utilization among control participants of a randomized clinical trial (RCT).

Methods: We retrospectively analyzed electronic medical records from the control arm (n = 26) of an RCT involving low-income Hispanic adults with type 2 diabetes receiving care at a community clinic. Before randomization to a 12-month diabetes education intervention or usual care (control), participants underwent on-site measurements of HbA1c, blood pressure, and weight. Healthcare utilization among control participants was compared during the year before and throughout the study, including all types of exposures: provider visits and other services (eg, orders).

Results: Total healthcare utilization was similar between the pre-period (11.9 exposures/year) and the study-period (11.4 exposures/year; P = .93), with no significant changes across visit types. There were no significant differences in fitted mean monthly visits between the pre- and study-periods (P = .93), nor over time (P = .89).

Conclusions: This exploratory study found no evidence of a Hawthorne effect on healthcare utilization among control participants. While this may suggest consistent healthcare behaviors, it may also highlight an important public health concern: individuals in low-income settings may lack the resources to translate increased awareness into health-related action. Larger studies are needed to further elucidate behavioral patterns in low-income populations.

Keywords

Adult, Aged, Female, Humans, Male, Middle Aged, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Hispanic or Latino, Patient Acceptance of Health Care, Poverty, Randomized Controlled Trials as Topic, Retrospective Studies, resource-limited or low-income, Hispanic, diabetes, Hawthorne effect, control, clinical trial

Published Open-Access

yes

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