Chronic Disease Self-Management Program Research Articles

How can we realize the health promotion measures for all the people in a mature society, Japan?– Proposing for "collaboration between academy and practice" in Japanese public health by Self-Management Education, especially Chronic Disease Self-Management Program

How can we realize the health promotion measures for all the people in a mature society, Japan?– Proposing for "collaboration between academy and practice" in Japanese public health by Self-Management Education, especially Chronic Disease Self-Management Program

The Impact of the Chronic Disease Self-Management Program on Health Literacy: A Pre-Post Study Using a Multi-Dimensional Health Literacy Instrument.

This study assessed the impact of the Chronic Disease Self-Management Program (CDSMP) on different domains of health literacy using a pre-post study design. Participants aged over 16 years and with one or more self-reported chronic diseases were recruited for the CDSMP in western Sydney (a highly diverse area of New South Wales, Australia) between October 2014 and September 2018. Health literacy was assessed pre- and immediately post-intervention using the Health Literacy Questionnaire (HLQ), with differences in mean scores for each HLQ domain analysed using paired sample t-tests. A total of 486 participants were recruited into the CDSMP. Of those, 316 (65.0%) completed both pre- and post-intervention surveys and were included in the analysis. The median age of the participants was 68 years, the majority were female (62.5%), and most were born in a country other than Australia (80.6%). There were statistically significant (P < 0.001) improvements across all nine domains of the HLQ. This is the first study evaluating the potential impact of the CDSMP on improving different domains of health literacy amongst a diverse sample of participants with chronic diseases using a multi-dimensional instrument. The absence of a control population in this study warrants caution when interpreting the results.

EFFICHRONIC study protocol: a non-controlled, multicentre European prospective study to measure the efficiency of a chronic disease self-management programme in socioeconomically vulnerable populations

IntroductionMore than 70% of world mortality is due to chronic conditions. Furthermore, it has been proven that social determinants have an enormous impact on both health-related behaviour and on the...

Translating the Chronic Disease Self-Management Program for Community-Dwelling Adults With Developmental Disabilities.

Objective: The study was to test the feasibility of supplementary materials (DD-CDSMP) supporting people with developmental disabilities who are aging to participate in the Chronic Disease Self-Management Program (CDSMP). CDSMP is a six-session group intervention designed to increase self-management of chronic health conditions. Method: Supplementary materials were utilized within two CDSMP workshops. Each workshop involved seven to nine persons with developmental disabilities and five to seven staff. Supplementary materials to the existing intervention manual were reviewed using a framework for modifications and adaptions for evidence-based interventions. Process interviews with leaders and participants, pre- and posttests on self-management activity and satisfaction surveys assessed outcomes and feasibility. Results: Classes were successfully held with a 70% completer rate, and all materials proved useful. Discussion: People with developmental disabilities as they age tend to have more comorbid conditions than the general population. Developing and implementing materials and strategies to making self-management more accessible to people with developmental disabilities in mainstream rather than segregated settings will improve the quality of people's lives.

Geographic disparities associated with travel to medical care and attendance in programs to prevent/manage chronic illness among middle-aged and older adults in Texas.

Accessing care is challenging for adults with chronic conditions. The challenge may be intensified for individuals needing to travel long distances to receive medical care. Transportation difficulties are associated with poor medication adherence and delayed or missed care. This study investigated the relationship between those traveling greater distances for medical care and their utilization of programs to prevent and/or manage their health problems. It was hypothesized that those traveling longer distances for medical care attended greater chronic disease management programs. Thirty six thousand households in nine counties of central Texas received an invitation letter to participate in a mailed health assessment survey in English or Spanish. A total of 5230 participants agreed to participate and returned the fully completed survey. To investigate distance traveled for medical services and participation in a chronic disease management program, the analyses were limited to 2108 adults aged &ge;51 years with one or more chronic conditions who visited a healthcare professional at least once in the previous year. Other variables of interest included residential rurality, health status, and personal characteristics. The data were first analyzed using descriptive and bivariate analyses. Then, an ordinal logistic regression model was fitted to identify factors associated with longer distances traveled to medical services. Additionally, a binary logistic regression model was fitted to identify factors associated with attending a chronic disease self-management program. Among 2108 adults, rural participants (p<0.001), those with more chronic conditions (p<0.001), and those attending a chronic disease program (p=0.037) reported traveling further distances to medical services. Participants with limited activity (p<0.001), those from urban counties (p=0.017), and those who traveled further (p=0.030) were more likely to attend a chronic disease program. While further distances to healthcare providers was found to be a protective factor based on the utilization of community-based resources, rural residents were less likely to attend a program to better manage their chronic conditions, potentially choosing to use long distance travel to address urgent medical needs rather than focusing on prevention and management of their conditions. Important policy and programmatic efforts are needed to increase reach of chronic disease self-management programs and other community services and resources in rural areas and to reduce rural inequities.

How can we realize the health promotion measures for all the people in a mature society, Japan?-Proposing for "collaboration between academy and practice" in Japanese public health by Self-Management Education, especially Chronic Disease Self-Management Program

How can we realize the health promotion measures for all the people in a mature society, Japan?-Proposing for "collaboration between academy and practice" in Japanese public health by Self-Management Education, especially Chronic Disease Self-Management Program

Efficacy and cost-effectiveness of behavioral interventions in nonclinical settings for improving health outcomes.

This paper examines three distinct examples of interventions in nonclinical settings selected to highlight the challenges and opportunities for evaluating cost-effectiveness in the field of health psychology and behavioral medicine. Nonclinical settings are defined as those involving systems outside of traditional medical/clinical settings, and include interventions tested in clinical settings that can also be implemented in nonclinical settings. The examples in this paper reflect the use of a varying degree of existing cost-effectiveness data and previous health economic analyses. First, the Chronic Disease Self-Management Program model reflects an intervention protocol designed to increase patients' confidence and mastery in their ability to manage their conditions that has been shown to be cost effective for a variety of chronic disease conditions. Second, the cost and cost-effectiveness of tobacco quitlines (e.g., National Tobacco Quit Line) has been the subject of several preliminary cost-effectiveness examinations and has proven to have significant reach and impact on tobacco-related behaviors. Finally, environmental interventions for promoting walking and physical activity in community-based contexts (e.g., PATH trial) are presented and have been shown to be highly relevant for demonstrating cost-effectiveness. Overall, the disciplines of health psychology and behavioral medicine are in a unique position to develop, implement, and evaluate a broader range of interventions in more diverse environments than cost-effectiveness applications in more traditional, clinical settings. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Chronic Obstructive Pulmonary Disease and Arthritis Among US Adults, 2016.

IntroductionMore than 54 million US adults have arthritis, and more than 15 million US adults have chronic obstructive pulmonary disease (COPD). Arthritis and COPD share many risk factors, such as tobacco use, asthma history, and age. The objective of this study was to assess the relationship between self-reported physician-diagnosed COPD and arthritis in the US adult population. MethodsWe analyzed data from 408,774 respondents aged 18 or older in the 2016 Behavioral Risk Factor Surveillance System to assess the association between self-reported physician-diagnosed COPD and arthritis in the US adult population by using multivariable logistic regression analyses.ResultsOverall crude prevalence was 6.4% for COPD and 25.2% for arthritis. The prevalence of age-adjusted COPD was higher among respondents with arthritis than among respondents without arthritis (13.7% vs 3.8%, P < .001). The association remained significant among most subgroups (P < .001) particularly among adults aged 18 to 44 (11.5% vs 2.0%) and never smokers (7.6% vs 1.7%). In multivariable logistic regression analyses, arthritis status was significantly associated with COPD status after controlling for sociodemographic characteristics, risk behaviors, and health-related quality of life measures (adjusted prevalence ratio = 1.5, 95% confidence interval, 1.4–1.5, P < .001).ConclusionOur results confirmed that arthritis is associated with a higher prevalence of COPD in the US adult population. Health care providers may assess COPD and arthritis symptoms for earlier detection of each condition and recommend that patients with COPD and/or arthritis participate in pulmonary rehabilitation and self-management education programs such as the Chronic Disease Self-Management Program, the proven benefits of which include increased aerobic activity and reduced shortness of breath, pain, and depression.

Changes in exercise capacity and anthropometric measures after Work It Out—a holistic chronic disease self-management program for urban Aboriginal and Torres Strait Islander people

ObjectivesThe Work It Out (WIO) program is a holistic chronic disease self-management and rehabilitation program in Queensland that is tailored for urban Aboriginal and Torres Strait Islander people with/at risk of chronic disease. This study aimed to examine the overall changes in participants’ exercise capacity and anthropometric measurements and to explore the correlations between these changes. Study designQuasi-experimental prepost intervention study. MethodsA total of 406 participants self-identified as Aboriginal and Torres Strait Islander people, who had attended one or more cycles of the program from 2014 to 2017, were included. Health information from the last review assessment was compared with that of the initial assessment using paired t-tests. Multivariate regression models were applied to explore the associations between changes in 6-min walk distance (6MWD) and anthropometric measurements. ResultsAn increase in 6MWD (77 m, 95% confidence interval [CI]: 65, 90), as well as small reductions in waist circumference (WC) (−1.79 cm, 95% CI: −2.76 to −0.82) and hip circumference (−1.11 cm, 95% CI: −2.13 to −0.08) were identified. Statistically significant reductions were observed across all anthropometric measures in the respective highest tertiles (body mass index: −0.71, 95% CI: −1.35 to −0.07; weight: −2.59 kg, 95% CI: −4.84 to −0.34; WC: −5.09 cm, 95% CI: −6.99 to −3.20; waist to hip ratio: −0.033, 95% CI: −0.047 to −0.02). The increments of 6MWD in returning participants (92 m, 95% CI: 75 to 109) was found to be greater than those in one-off participants (59 m, 95% CI: 40–78). In particular, the percentage of 6MWD change from baseline was significantly correlated to the percentage of WC change after adjusting for age, gender, the number of pre-existing chronic conditions, and the number of cycles attended (coefficient: −1.33, 95% CI: −2.42 to −0.24). ConclusionSignificant improvement in functional exercise capacity and modest changes in anthropometric measurements were identified in WIO participants. WC change could be used as an indicator of the change of participants’ six-minute walk distance. Findings may be useful for promoting and guiding similar health programs for improving chronic disease management in Australian Indigenous communities.

Trajectories of change after a health-education program in Japan: decay of impact in anxiety, depression, and patient-physician communication.

BackgroundHealth education can benefit people with chronic diseases. However, in previous research those benefits were small, and reinforcement to maintain them was not effective. A possible explanation is that the benefits appeared to be small and reinforcement appeared to be ineffective because those analyses mixed data from two latent groups: one group of people who needed reinforcement and one group of people who did not. The hypothesis is that mixing the data from those two different groups caused the true effects to be “diluted.”MethodsTo test that hypothesis we used data from the Chronic Disease Self-Management Program in Japan, focusing on anxiety, depression, and patient-physician communication. To identify latent trajectories of change after the program, we used growth-mixture modeling. Then, to find out which baseline factors were associated with trajectory-group membership, we used logistic regression.ResultsGrowth-mixture modeling revealed two trajectories—two groups that were defined by distinct patterns of change after the program. One of those patterns was improvement followed by backsliding: decay of impact. On anxiety and depression the decay of impact was large enough to be clinically important, and its prevalence was as high as 50%. Next, logistic regression analysis revealed that being in the decay-of-impact group could be predicted from multimorbidity, low self-efficacy, and high scores on anxiety or depression at baseline. In addition, one unexpected finding was an association between multimorbidity and better patient-physician communication.ConclusionsThese results support the hypothesis that previous findings (i.e., apparently small effect sizes and apparently ineffective reinforcement) actually reflect “dilution” of large effects, which was caused by mixing of data from distinct groups. Specifically, there was one group with decay of impact and one without. Thus, evaluations of health education should include analyses of trajectory-defined groups. These results show how the group of people who are most likely to need reinforcement can be identified even before the educational program begins. Extra attention and reinforcement can then be tailored. They can be focused specifically to benefit the people with the greatest need.

Chronic disease self-management programs for Aboriginal and Torres Strait Islander people: Factors influencing participation in an urban setting.

Evidence suggests that participation in a Chronic Disease Self-Management (CDSM) program improves the health of clients. Many factors are known to influence participation in these programs for the broader Australian population. However, less is known about why Aboriginal and Torres Strait Islanders choose to participate. This study identifies key factors that support or enable Aboriginal and Torres Strait Islanders to participate in a CDSM program in an urban setting. Twelve focus groups were undertaken with a total of 102 participants who were diagnosed with or at risk of chronic disease. These participants were recruited from the Work It Out program, a CDSM program comprising exercise and health education. The Work It Out program is specifically designed for Aboriginal and Torres Strait Islanders and delivered by an Aboriginal led and community-controlled organisation in South-East and Central Queensland. The study received ethical clearance through the Behavioural and Social Sciences Ethical Review Committee at The University of Queensland (Approval Number 2011001283). Findings indicate that key features of program design based on a culturally responsive approach influences participation. The main features are as follows: providing easy access to the program; permitting flexibility in attendance; a group environment; the approach of program staff that prioritises relationship building; personalised and integrated care; communicating result regularly; and ensuring community ownership of the program. These findings are useful to consider when designing a health program for Aboriginal and Torres Strait Islanders. Programs which are culturally responsive and include the design features identified in this study are more likely to increase participation amongst Aboriginal and Torres Strait Islanders. SO WHAT?: Increasing participation of Aboriginal and Torres Strait Islanders in CDSM programs using the design features identified in the paper may contribute significantly in closing the health disparity gap.

Effect of chronic disease self-management program on the quality of life of HIV-infected men who have sex with men: An empirical study in Shanghai, China.

The HIV/AIDS epidemic rages on in China, particularly among men who have sex with men (MSM). MSM with HIV/AIDS also tend to have poorer quality of life than other members of the population. A major contributor to these issues is the huge gap between the increasing demand of MSM for medical services and the availability of such services; their current needs cannot be met only with the services of the Chinese Center for Disease Control and Prevention. The aim of the present study was to examine the quality of life of MSM with HIV/AIDS in Shanghai, as well as determine whether it is influenced by chronic disease self-management (CDSM). We conducted a pre-post study to evaluate the effect of CDSM on participants' quality of life. Four hundred twenty participants were assigned to either the CDSM group (n = 210) or the control group (n = 210). We collected data on quality of life (using the Medical Outcomes Study HIV Health Survey [MOS-HIV]) and various psychological and behavioral variables via interviewer-administered questionnaires. The physical and mental health summary scores of the MOS-HIV were 53.7 and 49.9, respectively. The CDSM group showed a significant improvement in quality of life and a significant decrease in the proportion of participants with anxiety symptoms (from 38.6% to 22.6%). Furthermore, the frequency of condom use increased from 43.3% to 47.3%. MSM with HIV generally had low quality of life in Shanghai. The CDSM program might help promote the quality of life of MSM while helping them practice healthy behaviors.

Health service utilization among African American women living with systemic lupus erythematosus: perceived impacts of a self-management intervention

BackgroundHealthcare access, utilization, and quality play critical roles in shaping mortality and morbidity among patients diagnosed with systemic lupus erythematosus (SLE), and yet healthcare access, utilization, and quality can be suboptimal for many people living with SLE. The aim of this qualitative study was to explore the perceived impact of a peer-led, group-based educational intervention (the Chronic Disease Self-Management Program [CDSMP]) on healthcare engagement behaviors among African American women with SLE.MethodsParticipants were recruited from the WELL (Women Empowered to Live with Lupus) study, a behavioral trial of the effectiveness of the CDSMP on African American women diagnosed with SLE. We conducted two waves of qualitative, one-on-one, semi-structured interviews with 24 purposively sampled WELL participants; one interview was conducted before CDSMP participation and one after. Wave 1 interviews explored health service use behaviors at baseline; Wave 2 interviews focused on changes in these behaviors post-intervention and women’s perceptions of whether and how the CDSMP shaped these changes. Transcripts were analyzed using thematic analysis methods.ResultsStudy participants perceived the CDSMP to be a valuable resource for supporting two distinct health service use behaviors: communicating with doctors (N = 16 [88.9%]) and managing medication side effects (N = 17 [41.2%]). Women perceived that the CDSMP had the most potent and widespread effects on patients’ communication with doctors. Strategies that women believed generated improvements in patient-doctor communication included enhancing preparation for appointments and boosting patient participation during doctor’s visits. Women’s reported post-CDSMP improvements in health service use behaviors varied by disease severity and depression. Insurance coverage, while not probed directly during baseline interviews, emerged organically as a key factor affecting health service use behaviors; the CDSMP did not seem to improve participants’ ability to circumvent insurance-related barriers to accessing care.ConclusionsOur findings suggest that the CDSMP may help enhance healthcare service utilization among African American women with SLE by improving doctor/patient communication and medication side effect management. If future research confirms this conclusion, African American women living with SLE should be encouraged to participate in CDSMP workshops to enhance health service use behaviors.Trial registrationNCT02988661. Registered 12/07/2016

Participation of lower-to-middle wage workers in a study of Chronic Disease Self-Management Program (CDSMP) effectiveness: Implications for reducing chronic disease burden among racial and ethnic minority populations.

Although the Chronic Disease Self-Management Program (CDSMP) improves chronic disease outcomes, little is known about CDSMP participation in populations less than 65years of age. We explore study and CDSMP participation rates by demographic characteristics with younger (40-64years old), lower-to-middle wage workers with chronic disease in a randomized clinical trial (RCT) conducted in North Carolina. Descriptive statistics and regression models were used to examine associations between demographic, chronic disease burden, and employment variables, and time-dependent study enrollment and intervention participation outcomes that ranged from initiating consent (n=1,067) to CDSMP completion (n=41). Overall, participation among non-Whites was disproportionately higher (43%-59%) than that of Whites (42%-57%) relative to the age-matched racial composition of North Carolina (31% non-White and 69% White). Among participants randomized to the CDSMP, racial and ethnic minorities had the highest rates of participation. There were no significant demographic, chronic disease burden, or employment predictors among the participation outcomes examined, although this may have been due to the limited number of CDSMP workshop participation observations. Extending the CDSMP to lower-to-middle wage workers may be particularly effective in reaching racial and ethnic minority populations, who complete the program to a greater extent than their White, non-Hispanic counterparts.

Evaluation Design of EFFICHRONIC: The Chronic Disease Self-Management Programme (CDSMP) Intervention for Citizens with a Low Socioeconomic Position.

Background/rationale: The Chronic Disease Self-Management Programme (CDSMP) intervention is an evidence-based program that aims to encourage citizens with a chronic condition, as well as their caregivers, to better manage and maintain their own health. CDSMP intervention is expected to achieve greater health gains in citizens with a low socioeconomic position (SEP), because citizens with a low SEP have fewer opportunities to adhere to a healthy lifestyle, more adverse chronic conditions and a poorer overall health compared to citizens with a higher SEP. In the EFFICHRONIC project, CDSMP intervention is offered specifically to adults with a chronic condition and a low SEP, as well as to their caregivers (target population). Study objective: The objective of our study is to evaluate the benefits of offering CDSMP intervention to the target population. Methods: A total of 2500 participants (500 in each study site) are recruited to receive the CDSMP intervention. The evaluation study has a pre-post design. Data will be collected from participants before the start of the intervention (baseline) and six months later (follow up). Benefits of the intervention include self-management in healthy lifestyle, depression, sleep and fatigue, medication adherence and health-related quality of life, health literacy, communication with healthcare professionals, prevalence of perceived medical errors and satisfaction with the intervention. The study further includes a preliminary cost-effectiveness analysis with a time horizon of six months. Conclusion: The EFFICHRONIC project will measure the effects of the CDSMP intervention on the target population and the societal cost savings in five European settings.

Felty syndrome. Case report

The Work It Out (WIO) program is a holistic chronic disease self-management and rehabilitation program in Queensland that is tailored for urban Aboriginal and Torres Strait Islander people with/at risk of chronic disease. This study aimed to examine the overall changes in participants’ exercise capacity and anthropometric measurements and to explore the correlations between these changes.Quasi-experimental prepost intervention study.A total of 406 participants self-identified as Aboriginal and Torres Strait Islander people, who had attended one or more cycles of the program from 2014 to 2017, were included. Health information from the last review assessment was compared with that of the initial assessment using paired t-tests. Multivariate regression models were applied to explore the associations between changes in 6-min walk distance (6MWD) and anthropometric measurements.An increase in 6MWD (77 m, 95% confidence interval [CI]: 65, 90), as well as small reductions in waist circumference (WC) (−1.79 cm, 95% CI: −2.76 to −0.82) and hip circumference (−1.11 cm, 95% CI: −2.13 to −0.08) were identified. Statistically significant reductions were observed across all anthropometric measures in the respective highest tertiles (body mass index: −0.71, 95% CI: −1.35 to −0.07; weight: −2.59 kg, 95% CI: −4.84 to −0.34; WC: −5.09 cm, 95% CI: −6.99 to −3.20; waist to hip ratio: −0.033, 95% CI: −0.047 to −0.02). The increments of 6MWD in returning participants (92 m, 95% CI: 75 to 109) was found to be greater than those in one-off participants (59 m, 95% CI: 40–78). In particular, the percentage of 6MWD change from baseline was significantly correlated to the percentage of WC change after adjusting for age, gender, the number of pre-existing chronic conditions, and the number of cycles attended (coefficient: −1.33, 95% CI: −2.42 to −0.24).Significant improvement in functional exercise capacity and modest changes in anthropometric measurements were identified in WIO participants. WC change could be used as an indicator of the change of participants’ six-minute walk distance. Findings may be useful for promoting and guiding similar health programs for improving chronic disease management in Australian Indigenous communities.

Using Transcultural Nursing Education to Increase Cultural Sensitivity and Cultural Assessment Documentation by Staff in an In-Home Chronic Disease Self-Management Program.

Despite literature indicating that culturally sensitive care promotes a positive patient environment and may help improve outcomes, limited data exist on the documentation of patients' cultural concerns in electronic medical records (EMR). The project's objective was to use an educational intervention to increase clinic staff's cultural sensitivity and cultural assessment documentation. Researchers conducted this 3-month project at a Midwestern clinic's in-home, self-care chronic disease management program. The voluntary sample of clinical staff (n = 8) received an educational intervention on transcultural nursing practices. Researchers administered the Transcultural Self-Efficacy Tool for the Multidisciplinary Healthcare Provider (TSET-MHP) to participants before and after the intervention. A pre- and postintervention EMR audit was completed on 128 charts to evaluate cultural assessment documentation. TSET-MHP cognitive and practical subscales scores increased postintervention. Affective subscales scores decreased slightly. Electronic cultural assessment documentation increased by 10%. An assessment questionnaire showed an increase in participants' cultural self-awareness and comfort with cultural assessment. An educational intervention demonstrated an increase in providers' cultural awareness and cultural assessment documentation. Transcultural nursing education may help increase providers' perceived cultural self-efficacy, which may improve cultural assessments and culturally competent care.

Geographic and Social Factors Associated With Chronic Disease Self-Management Program Participation: Going the "Extra-Mile" for Disease Prevention.

IntroductionWe examined geographic and social factors associated with participation in the Chronic Disease Self-Management Program (CDSMP) and the Diabetes Self-Management Program (DSMP) implemented at 144 sites in Illinois.MethodsPrograms were delivered by trained facilitators, once per week, during 6 weeks to 1,638 participants aged 50 or older. Of the 1,638 participants, we included in our analysis 1,295 participants with complete geographic information and baseline data on demographic characteristics, health history, and health behaviors. We assessed the following program data: program type (CDSMP or DSMP), workshop location, class size, and number of sessions attended by participants. We geocoded each participant’s home address, classified the home address as rural or urban, and calculated the distance traveled from the home address to a workshop. We used linear and logistic regression analyses to examine the associations between participant and program factors with number of sessions attended and odds of program completion by whether participants lived in an urban or rural county.ResultsAverage program attendance was 4.2 sessions; 71.1% (1,106 of 1,556) completed 4 or more sessions. Most participants enrolled in CDSMP (59.6% [954 of 1,600]), but DSMP had greater completion rates. Less than 7% (85 of 1,295) of our sample lived in a rural county; these participants had better completion rates than those living in urban counties (89.4% [76 of 85] vs 75.6% [890 of 1,178]). Traveling shorter distances to attend a workshop was significantly associated with better attendance and program completion rates among urban but not rural participants. The number of sessions attended was significantly higher when class size exceeded 16 participants. Not having a high school diploma was significantly associated with lower levels of attendance and program completion.ConclusionParticipation in CDSMP and DSMP was associated with distance traveled, program type, class size, and education. Increasing participation in self-management programs is critical to ensure participants’ goals are met.

Abstract TMP74: Factors Associated With Participation in Self-Management Programs: Findings From the SUCCEED ( S econdary Stroke Prevention by U niting C ommunity and C hronic Care Model Teams E arly to E nd D isparities) Trial

Background: Self-management programs have been shown to improve quality of life and self-efficacy for stroke survivors, but participation is often low. We are conducting a randomized controlled trial (RCT) of a complex, multidisciplinary, team-based intervention, SUCCEED, to improve risk factor control after stroke in a safety-net setting. Intervention participants are offered Chronic Disease Self-Management Program (CDSMP) workshops. We implemented strategies to increase participation, including monetary incentives, free transportation, workshops at community venues, inviting family and caregivers, and accommodating participants’ schedules. Objectives: To determine factors associated with participation and with extent of participation in a series of 6 sessions. Methods: From 2014 to 2017, 487 English and Spanish-speaking individuals (age&gt;40 years) with stroke or TIA were enrolled in SUCCEED; 241 were randomized to intervention and offered CDSMP. Multivariable logistic and linear regression analyses were used to identify factors associated with CDSMP participation, including age, race/ethnicity, gender, employment status at 3 months, marital status, competing needs in 6 months prior to index stroke, life chaos, depression (PHQ-9), and disability (modified Rankin score). Results: Of 241 in the intervention arm, 29% (n=70) attended at least one CDSMP session (median sessions attended=4; IQR 2, 6). Unemployment at 3 months was associated with participation (adjusted OR=12.6, 95% CI 2.3, 69.7). Individuals were less likely to participate if they were not married or in a domestic partnership (OR=0.4, 95% CI 0.2, 0.9) or had foregone seeing a doctor in the 6 months prior to stroke because of caregiving responsibilities (OR=0.3, 95% CI 0.1, 1.0). Greater disability was associated with attendance at more sessions (p=0.03). Conclusion: Less than one third of participants attended CDSMP classes. Although we addressed financial and transportation barriers to participation, employment and caregiving responsibilities adversely impacted engagement. Spousal support was a key facilitator. Those with more severe disability were potentially more motivated to participate in CDSMP.

Predictors of Health Self-Management Program Preference Among Lower-to-Middle Wage Employed Adults With Chronic Health Conditions.

We examined the extent to which demographic, chronic disease burden, and financial strain characteristics were associated with a preference for engaging in the Chronic Disease Self-Management Program (presented as a "health self-management program" [HSMP]) over a financial self-management program (FSMP) and a no program preference (NPP) group among employed adults. Cross-sectional, correlation design using baseline data from a randomized controlled trial (RCT). The analytic sample included 324 workers aged 40 to 64 years with 1 or more chronic disease conditions recruited into the RCT from 2015 to 2017. Chronic disease burden measures included the number of chronic conditions, body mass index (BMI), and the 8-item and 15-item Patient Health Questionnaire (PHQ-8 and PHQ-15). Financial strain was measured as the inability to purchase essentials and food assistance receipt. Both individual and household measures of income were assessed. Multinomial logistic regression and post-hoc marginal effects models. Moderate-to-severe depressive symptoms increased the likelihood of having an HSMP preference when compared with those preferring the FSMP (RR = 4.2, P < .05) but not those having NPP; while higher BMI marginally increased HSMP preference over FSMP preference, but not NPP groups (RR = 1.04, P < .05). Financial strain differentially, but significantly, reduces the likelihood of HSMP preference at varying levels of household poverty, depressive symptom severity, and financial strain. Middle-aged, lower-to-middle income workers with moderate-to-severe depressive symptoms opt for HSMPs over FSMPs, but preference for HSMPs significantly diminished when they are experiencing financial strain.