Chronic Disease Self-management Education Research Articles

Picture Good Health: A Church-Based Self-Management Intervention Among Latino Adults with Diabetes.

Churches may provide a familiar and accessible setting for chronic disease self-management education and social support for Latinos with diabetes. We assessed the impact of a multi-faceted church-based diabetes self-management intervention on diabetes outcomes among Latino adults. This was a community-based, randomized controlled, pilot study. One-hundred adults with self-reported diabetes from a Midwestern, urban, low-income Mexican-American neighborhood were included in the study. Intervention participants were enrolled in a church-based diabetes self-management program that included eight weekly group classes led by trained lay leaders. Enhanced usual care participants attended one 90-minute lecture on diabetes self-management at a local church. The primary outcome was change in glycosylated hemoglobin (A1C). Secondary outcomes included changes in low-density lipoproteins (LDL), blood pressure, weight, and diabetes self-care practices. Participants' mean age was 54 ± 12 years, 81 % were female, 98 % were Latino, and 51 % were uninsured. At 3 months, study participants in both arms decreased their A1C from baseline (-0.32 %, 95 % confidence interval [CI]: -0.62, -0.02 %). The difference in change in A1C, LDL, blood pressure and weight from baseline to 3-month and 6-month follow-up was not statistically significant between the intervention and enhanced usual care groups. Intervention participants reported fewer days of consuming high fat foods in the previous week (-1.34, 95 % CI: -2.22, -0.46) and more days of participating in exercise (1.58, 95 % CI: 0.24, 2.92) compared to enhanced usual care from baseline to 6 months. A pilot church-based diabetes self-management intervention did not reduce A1C, but resulted in decreased high fat food consumption and increased participation in exercise among low-income Latino adults with diabetes. Future church-based interventions may need to strengthen linkages to the healthcare system and provide continued support to participants to impact clinical outcomes.

Fostering Healthy Aging through Evidence-Based Prevention Programs: Perspectives from the Administration for Community Living/Administration on Aging.

Fostering Healthy Aging through Evidence-Based Prevention Programs: Perspectives from the Administration for Community Living/Administration on Aging.

Improving Lives through Evidence-Based Health Promotion Programs: A National Priority.

Improving Lives through Evidence-Based Health Promotion Programs: A National Priority.

Chronic Disease Self-Management Education (CDSME) Program Delivery and Attendance among Urban-Dwelling African Americans.

Older African Americans carry a disproportionate share of chronic diseases. The purpose of this study was to identify the characteristics of urban-dwelling African Americans with chronic disease participating in Chronic Disease Self-Management Education (CDSME) programs and to examine factors related to successful program completion (i.e., attending at least four of the six sessions). Data were analyzed from 11,895 African Americans who attended a CDSME program at one of the five leading delivery sites (i.e., senior center, health care organization, residential facility, community location, faith-based organization). Logistic regression analyses were used to assess the associations of demographic, delivery site, and neighborhood characteristics with CDSME program successful completion. Approximately, half of the African American participants were aged 65-79 years, 83% were female, and 92% lived alone. Approximately, 44% of participants had three or more chronic conditions and 35% resided in an impoverished area (i.e., 200% below federal poverty level). Successful completion of the CDSME program was associated with being between the ages of 50-64 and 65-79 years, being female, living alone, living in an impoverished community, and attending a CDSME program at a residential facility or community center. Findings highlight the unique patterns of attendance and delivery within the context of self-management interventions among this unique and traditionally underserved target population. Understanding such patterns can inform policy and practice efforts to engage more organizations in urban areas to increase CDSME program adoption. Particularly, employing strategies to implement CDSME programs across all delivery site types may increase reach to African American participants.

Healthcare cost savings estimator tool for chronic disease self-management program: a new tool for program administrators and decision makers.

Chronic disease self-management education (CDSME) programs have been delivered to more than 100,000 older Americans with chronic conditions. As one of the Stanford suite of evidence-based CDSME programs, the chronic disease self-management program (CDSMP) has been disseminated in diverse populations and settings. The objective of this paper is to introduce a practical, universally applicable tool to assist program administrators and decision makers plan implementation efforts and make the case for continued program delivery. This tool was developed utilizing data from a recent National Study of CDSMP to estimate national savings associated with program participation. Potential annual healthcare savings per CDSMP participant were calculated based on averted emergency room visits and hospitalizations. While national data can be utilized to estimate cost savings, the tool has built-in features allowing users to tailor calculations based on their site-specific data. Building upon the National Study of CDSMP’s documented potential savings of $3.3 billion in healthcare costs by reaching 5% of adults with one or more chronic conditions, two heuristic case examples were also explored based on different population projections. The case examples show how a small county and large metropolitan city were not only able to estimate healthcare savings ($38,803 for the small county; $732,290 for the large metropolitan city) for their existing participant populations but also to project significant healthcare savings if they plan to reach higher proportions of middle-aged and older adults. Having a tool to demonstrate the monetary value of CDSMP can contribute to the ongoing dissemination and sustainability of such community-based interventions. Next steps will be creating a user-friendly, internet-based version of Healthcare Cost Savings Estimator Tool: CDSMP, followed by broadening the tool to consider cost savings for other evidence-based programs.

Workshop characteristics related to chronic disease self-management education program attendance.

Using the national dissemination of Chronic Disease Self-Management Education (CDSME) programs, the purposes of this study were to (1) document intervention attendance rates as related to the number of participants enrolled in the workshop and (2) compare the relationship between workshop attendance and workshop size by delivery site rurality and type. Data were analyzed from the first 100,000 middle-aged and older adults who participated in CDSME workshops spanning 45 states, Puerto Rico, and the District of Columbia as part of the American Recovery and Reinvestment Act of 2009 Communities Putting Prevention to Work: Chronic Disease Self-Management Program initiative. Descriptive statistics are reported for all participants, then separately by each delivery site type. Ratios between the number of workshop participants and the number of workshop sessions attended were calculated and graphed based on the rurality of delivery and separately for the leading five delivery site types. Associations between the number of workshop participants and the number of sessions attended differed by delivery site rurality and type. Findings have implications for participant retention and workshop delivery costs, which can assist program deliverers to strategically plan implementation efforts in their areas.

National dissemination of chronic disease self-management education programs: an incremental examination of delivery characteristics.

With a near 20-year developmental history as an evidence-based program, the suite of Chronic Disease Self-Management Education (CDSME) programs were selected in 2010 for grand-scale dissemination in a federally supported initiative to improve the health of older Americans. The primary charge of this national effort was to establish a sustainable program delivery system for empowering American adults with one or more chronic conditions to better manage their health. The current study focused on a series of dissemination and implementation science research questions to: (1) examine the geographic distribution of participation in this initiative across the Unites States; (2) describe workshop characteristics engaged to reach program participants in various settings; and (3) describe personal characteristics of the first 100,000 participants. Each subsequent entering cohort was descriptively examined to indicate whether there was constancy or change in delivery sites and populations reached over time. Findings show a strengthening of the workshop delivery infrastructure in that it took 9.4 months to reach the first 25,000 participants in 853 counties compared to 5.4 months to reach the last 25,000 participants in 1,109 counties. The workshop delivery characteristics and participant characteristics remained relatively consistent across increments of 25,000 participants reached, although general trends were observed for some variables. For example, after reaching the first 25,000 participants, subsequent groups of 25,000 participants were reached more quickly. Additionally, workshops were increasingly delivered in ZIP Codes with higher percentages of families residing below the federal poverty line. As more participants were reached, more participants with chronic conditions were enrolled. This national translational study illustrates the rapid expansion of CDSME programs throughout the United States and capability to reach diverse populations in a variety of settings.

Factors associated with Hispanic adults attending spanish-language disease self-management program workshops and workshop completion.

Many factors influence ways in which middle-aged and older Hispanic adults prefer to receive health-related information. While Spanish-language disease management programs are increasingly offered in community and healthcare settings, less is known about their utilization among the Hispanic population. This study aimed to identify participant and workshop factors associated with middle-aged and older Hispanic adults attending Spanish-language disease self-management program workshops and receiving the recommended intervention dose (i.e., successful workshop completion is defined as attending four or more of the six workshop sessions). Data were analyzed from 12,208 Hispanic adults collected during a national dissemination of the Stanford suite of Chronic Disease Self-Management Education (CDSME) programs spanning 45 states, the District of Columbia, and Puerto Rico. Two logistic regression analyses were performed. Over 65% of participants attended Spanish-language workshops, and 78.3% of participants successfully completed workshops. Relative to participants in English-language workshops, participants who attended Spanish-language CDSME workshops were more likely to successfully complete workshops, as were those aged 80 years and older, females, and those who lived alone. Participants who were aged 50–79 years and female were significantly more likely to attend Spanish-language workshops than their counterparts under age 50. Conversely, those with more chronic conditions were less likely to attend Spanish-language workshops. Those who attended workshops with more participants and where the Hispanic population was less affluent were more likely to attend Spanish-language workshops. This study provides insight into Spanish-language CDSME program recruitment and utilization with implications for program adoption in underserved Hispanic community settings.

Reaching diverse participants utilizing a diverse delivery infrastructure: a replication study.

This replication study examines participant recruitment and program adoption aspects of disease self-management programs by delivery site types. Data were analyzed from 58,526 adults collected during a national dissemination of the Stanford suite of chronic disease self-management education programs spanning 45 states, the District of Columbia, and Puerto Rico. Participant data were analyzed using multinomial logistic regression to generate profiles by delivery site type. Profiles were created for the five leading delivery site types, which included senior centers or area agencies on aging, residential facilities, healthcare organizations, community or multi-purpose centers, and faith-based organizations. Significant variation in neighborhood characteristics (e.g., rurality, median household income, percent of the population age 65 years and older, percent of the population i.e., non-Hispanic white) and participant characteristics (e.g., age, sex, ethnicity, race, rurality) were observed by delivery site type. Study findings confirm that these evidence-based programs are capable of reaching large numbers of diverse participants through the aging services network. Given the importance of participant reach and program adoption to the success of translational research dissemination initiatives, these findings can assist program deliverers to create strategic plans to engage community partners to diversify their participant base.

The reach of chronic-disease self-management education programs to rural populations.

This study assessed the sociodemographic characteristics of rural residents who participated in chronic-disease self-management education (CDSME) program workshops and the extent to which CDSME programs were utilized by those with limited access to health care services. We analyzed data from the first 100,000 adults who attended CDSME program workshops during a national dissemination spanning 45 states, the District of Columbia, and Puerto Rico. Approximately 24% of participants lived in rural areas. Overall, 42% of all participants were minorities; urban areas reached more minority participants (48%) than rural areas (25%). The average age of participants was high in rural (age, μ = 66.1) and urban (age, μ = 67.3) areas. In addition, the average number of chronic conditions was higher (p < 0.01) in rural (μ = 2.6 conditions) versus urban (μ = 2.4 conditions) areas. Successful completion of CDSME programs (i.e., attending four or more of the six workshop sessions) was higher (p < 0.01) in rural versus urban areas (78% versus 77%). Factors associated with higher likelihood of successful completion of CDSME programs included being Black (OR = 1.25) versus White and living in rural (versus urban) areas (OR = 1.09). Factors associated with lower likelihood of successful completion included being male (OR = 0.92) and residing in a primary care Health Professional Shortage Area or HPSA (versus a non-HPSA) (OR = 0.93). Findings highlight the capability of CDSME programs to reach rural residents, yet dissemination efforts can be further enhanced to ensure minorities and individuals in a HPSA utilize this program. Tailored strategies are needed to increase participant recruitment and retention in rural areas to overcome traditional barriers to health service access.

Your Life, Your Health!: Chronic Disease Self-management Education in Louisiana

Your Life, Your Health!: Chronic Disease Self-management Education in Louisiana

Understanding the Role of the Promotora in a Latino Diabetes Education Program

We explore the role of the promotora de salud (health promoter) who provided diabetes self-management education to Puerto Rican diabetics in her community. The education program was developed as a hospital and community-based organization partnership. Information from both Spanish-language focus groups with 35 class participants and an in-depth interview with the promotora indicated patients appreciated having the classes taught in Spanish by a Latina promotora from their community. Respondents reported satisfaction with the program, increased ability to self-manage diabetes, and strengthened connections with other Latino diabetics. Terms patients used for the promotora included comadre, hijita, and buena profesora. Some of these words denote almost kinship-level connections, suggesting that patients were forming strong connections with the promotora. Specific promotora roles were identified but varied among patients, promotora, and the literature. This hospital and community-based organization partnership promotora model appears to be effective for providing chronic disease self-management education in an urban community setting.

Comparison of the pre–post and transition question assessments in a health education setting

Objective This study examined the classical pre-intervention/post-intervention assessment (pre–post) and the single post-intervention transition question assessment (transition question) to determine how well these methods reflected qualitative interview–based participant-reported outcomes from chronic disease self-management education programs (CDSMEPs). Study Design and Setting A mixed-method qualitative and quantitative approach was applied in 25 interviews with participants recruited from CDSMEPs within Australia. Qualitative interviews with participants were used as a relative “gold standard” and compared with questionnaire-based pre–post and transition question assessments. Results Comparison of the two questionnaire-based assessments showed that most of the individual paired responses were discordant (61%). Using participant's qualitative narratives as a “true” indicator, the pre–post assessment was found on more occasions to be discordant with participant-reported outcomes than the transition question. The origin of the inconsistency was largely because of a change in respondents' perspective that had occurred after pretest, which was mediated by CDSMEPs' experiences and insights. Conclusion This study suggests that the pre–post assessment has poor validity for the assessment of health education program outcomes. Alternative assessments, such as the transition question, may result in a more accurate reflection of the impact of such programs on participants.

Enhancing patient engagement in chronic disease self‐management support initiatives in Australia: the need for an integrated approach

Although emphasis on the prevention of chronic disease is important, governments in Australia need to balance this with continued assistance to the 77% of Australians reported to have at least one long-term medical condition. Self-management support is provided by health care and community services to enhance patients' ability to care for their chronic conditions in a cooperative framework. In Australia, there is a range of self-management support initiatives that have targeted patients (most notably, chronic disease self-management education programs) and health professionals (financial incentives, education and training). To date, there has been little coordination or integration of these self-management initiatives to enhance the patient-health professional clinical encounter. If self-management support is to work, there is a need to better understand the infrastructure, systems and training that are required to engage the key stakeholders - patients, carers, health professionals, and health care organisations. A coordinated approach is required in implementing these elements within existing and new health service models to enhance uptake and sustainability.

Chronic disease self‐management education programs: challenges ahead

Chronic disease self-management education programs aim to empower patients through providing information and teaching skills and techniques to improve self-care and doctor-patient interaction, with the ultimate goal of improving quality of life. The recent 2006-07 federal budget allocated an unprecedented $515 million over 5 years for activation of patient self-management activities, commencing this financial year. Previous attempts in other countries to incorporate self-management education activities into the health care sector have faced setbacks because of inadequate integration into primary care. Engagement of health care professionals and their endorsement of self-management activities is critical to success.