{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:15:36Z","timestamp":1777983336482,"version":"3.51.4"},"reference-count":21,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100017618","name":"Division of Diabetes, Endocrinology, and Metabolic Diseases","doi-asserted-by":"publisher","award":["DK129474"],"award-info":[{"award-number":["DK129474"]}],"id":[{"id":"10.13039\/100017618","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Prim Care Community Health"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>In low-income settings, clinical trial participation may influence participant behavior, 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>To conduct a secondary exploratory analysis of healthcare utilization among control participants of a randomized clinical trial (RCT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We retrospectively analyzed electronic medical records from the control arm (n\u2009=\u200926) 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Total healthcare utilization was similar between the pre-period (11.9 exposures\/year) and the study-period (11.4 exposures\/year;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.93), with no significant changes across visit types. There were no significant differences in fitted mean monthly visits between the pre- and study-periods (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.93), nor over time (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.89).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21501319251379740","type":"journal-article","created":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T08:42:51Z","timestamp":1758962571000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Healthcare Utilization Unchanged in the Control Arm of a Randomized Clinical Trial"],"prefix":"10.1177","volume":"16","author":[{"given":"Pratik","family":"Gongloor","sequence":"first","affiliation":[{"name":"University of Texas Medical Branch, Galveston, TX, US"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saad","family":"Nadeem","sequence":"additional","affiliation":[{"name":"Texas A&amp;M School of Medicine, Bryan, TX, US"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoying","family":"Yu","sequence":"additional","affiliation":[{"name":"University of Texas Medical Branch, Galveston, TX, US"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mukaila","family":"Raji","sequence":"additional","affiliation":[{"name":"University of Texas Medical Branch, Galveston, TX, US"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristina D.","family":"Mena","sequence":"additional","affiliation":[{"name":"University of Texas School of Public Health, El Paso, TX, US"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9565-0134","authenticated-orcid":false,"given":"Elizabeth M.","family":"Vaughan","sequence":"additional","affiliation":[{"name":"University of Texas Medical Branch, Galveston, TX, US"},{"name":"Baylor College of Medicine, Houston, TX, US"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,9,27]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/qshc.2006.018093"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.08.015"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2020.07.028"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-019167"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/jep.12781"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-7-30"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2022.2779"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbspin.2018.10.003"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.100497"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.5271\/sjweh.1036"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-018-3292-5"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.1033486"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-022-07995-3"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40985-016-0043-2"},{"key":"e_1_3_2_16_2","first-page":"410","volume-title":"National Research Council (US) Panel on Hispanics in the United States","author":"Escarce JJ","year":"2006","unstructured":"Escarce JJ, Kapur K. Access to and quality of health care. In: Tienda M, Mitchell F (eds) National Research Council (US) Panel on Hispanics in the United States. Chapter 10. National Academies Press (US); 2006: 410-447."},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/21501319251339190"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2020.305579"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/0145721713486200"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-022-05736-z"},{"key":"e_1_3_2_21_2","unstructured":"National Overview | UnitedForALICE. 2025. Accessed August 29 2025. https:\/\/www.unitedforalice.org\/national-overview"},{"key":"e_1_3_2_22_2","unstructured":"Overview | UnitedForALICE. 2009-2025 United Way of Northern New Jersey. 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