Chronic Disease Self-Management Program Research Articles

Self-Management in Stroke Survivors: Development and Implementation of the Look after Yourself (LAY) Intervention.

Objective: Self-management is recommended in stroke rehabilitation. This report aims to describe timing, contents, and setting of delivery of a patient-centered, self-management program for stroke survivors in their early hospital rehabilitation phase: the Look After Yourself (LAY) intervention. Methods: After extensive literature search, the LAY intervention was developed by integrating the Chronic Disease Self-Management Program, based on the self-efficacy construct of social cognitive theory, with evidence-based key elements and input from stroke survivors. Results: the LAY intervention aims to implement self-management skills in stroke survivors, enabling them to be active in goal setting and problem solving using action plans and to facilitate the critical transition from hospital to community. It includes both group sessions to facilitate sharing of experiences, social comparison, vicarious learning, and increase motivation and one-to-one sessions focused on setting feasible action plans and on teaching personalized strategies to prevent falls. Standardization is ensured by manuals for facilitators and patients. Conclusion: The LAY intervention is the first Italian program to support early self-management in stroke rehabilitation; it has been experimented and its efficacy proven in improving self-efficacy, mental health, and activities of daily living, and detailed results have been published. The LAY intervention is described according to the TIDieR checklist.

Investigating the impact of a chronic disease self-management programme on depression and quality of life scores in an Irish sample

ABSTRACT Depression is more common among people with chronic conditions than in the general population and can negatively influence both health behaviours and outcomes. The Chronic Disease Self-Management Programme (CDSMP) is a six-week psycho-educational programme designed to promote self-efficacy and to teach patients skills for managing their chronic conditions. A longitudinal design evaluated the effect of the CDSMP on depression in an Irish cohort. Self-report data on psychological wellbeing were collected at baseline (n = 263), immediately post-program (n = 102), and six months (n = 81) after enrolment. CDSMP participation was associated with a significant decrease in the mean depression score of the whole sample, across the three time points. Significant improvements in quality of life and health interference in social activities were also observed among those who met criteria for depression on the PHQ-8 at baseline, but not their peers with sub-threshold depression scores. Quality of life continued to improve between the end of the programme and 6-month follow-up. These findings support the efficacy of the CDSMP in the treatment of chronic conditions, as well as its role in promoting sustainable changes to quality of life.

Effect of a Coordinated Community and Chronic Care Model Team Intervention vs Usual Care on Systolic Blood Pressure in Patients With Stroke or Transient Ischemic Attack

Few stroke survivors meet recommended cardiovascular goals, particularly among racial/ethnic minority populations, such as Black or Hispanic individuals, or socioeconomically disadvantaged populations. To determine if a chronic care model-based, community health worker (CHW), advanced practice clinician (APC; including nurse practitioners or physician assistants), and physician team intervention improves risk factor control after stroke in a safety-net setting (ie, health care setting where all individuals receive care, regardless of health insurance status or ability to pay). This randomized clinical trial included participants recruited from 5 hospitals serving low-income populations in Los Angeles County, California, as part of the Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities (SUCCEED) clinical trial. Inclusion criteria were age 40 years or older; experience of ischemic or hemorrhagic stroke or transient ischemic attack (TIA) no more than 90 days prior; systolic blood pressure (BP) of 130 mm Hg or greater or 120 to 130 mm Hg with history of hypertension or using hypertensive medications; and English or Spanish language proficiency. The exclusion criterion was inability to consent. Among 887 individuals screened for eligibility, 542 individuals were eligible, and 487 individuals were enrolled and randomized, stratified by stroke type (ischemic or TIA vs hemorrhagic), language (English vs Spanish), and site to usual care vs intervention in a 1:1 fashion. The study was conducted from February 2014 to September 2018, and data were analyzed from October 2018 to November 2020. Participants randomized to intervention were offered a multimodal coordinated care intervention, including hypothesized core components (ie, ≥3 APC clinic visits, ≥3 CHW home visits, and Chronic Disease Self-Management Program workshops), and additional telephone visits, protocol-driven risk factor management, culturally and linguistically tailored education materials, and self-management tools. Participants randomized to the control group received usual care, which varied by site but frequently included a free BP monitor, self-management tools, and linguistically tailored information materials. The primary outcome was change in systolic BP at 12 months. Secondary outcomes were non-high density lipoprotein cholesterol, hemoglobin A1c, and C-reactive protein (CRP) levels, body mass index, antithrombotic adherence, physical activity level, diet, and smoking status at 12 months. Potential mediators assessed included access to care, health and stroke literacy, self-efficacy, perceptions of care, and BP monitor use. Among 487 participants included, the mean (SD) age was 57.1 (8.9) years; 317 (65.1%) were men, and 347 participants (71.3%) were Hispanic, 87 participants (18.3%) were Black, and 30 participants (6.3%) were Asian. A total of 246 participants were randomized to usual care, and 241 participants were randomized to the intervention. Mean (SD) systolic BP improved from 143 (17) mm Hg at baseline to 133 (20) mm Hg at 12 months in the intervention group and from 146 (19) mm Hg at baseline to 137 (22) mm Hg at 12 months in the usual care group, with no significant differences in the change between groups. Compared with the control group, participants in the intervention group had greater improvements in self-reported salt intake (difference, 15.4 [95% CI, 4.4 to 26.0]; P = .004) and serum CRP level (difference in log CRP, -0.4 [95% CI, -0.7 to -0.1] mg/dL; P = .003); there were no differences in other secondary outcomes. Although 216 participants (89.6%) in the intervention group received some of the 3 core components, only 35 participants (14.5%) received the intended full dose. This randomized clinical trial of a complex multilevel, multimodal intervention did not find vascular risk factor improvements beyond that of usual care; however, further studies may consider testing the SUCCEED intervention with modifications to enhance implementation and participant engagement. ClinicalTrials.gov Identifier: NCT01763203.

The application value of chronic disease self-management project in promoting pulmonary rehabilitation of patients with chronic obstructive pulmonary disease

Objective: To explore the role of chronic disease self-management program (CDSMP) in promoting pulmonary rehabilitation of patients with chronic obstructive pulmonary disease (COPD) . Methods: In June 2017 and December 2018, 380 COPD patients were selected from the health management center of Qilu Hospital of Shandong University during the same period. They were randomly divided into the experimental group and the control group. At the end of the study, 17 cases were lost to follow-up and 5 cases were withdrawn from the study. Finally, 175 and 183 patients in the experimental group and the control group completed the study. The experimental group was treated with CDSMP for 6 months, while the control group was not intervened. Lung function and blood gas analysis results, lung rehabilitation related indicators and SF-36 scores were compared between the two groups before and after intervention. The measurement data were expressed by Mean±SD, and the comparison between the two groups was performed by t test. The count data were expressed by frequency and constituent ratio (%) . Chi square test or rank sum test was used for comparison between groups. Results: After CDSMP intervention, compared with the control group, the 6MWD, weekly moderate intensity exercise time, weekly moderate intensity exercise frequency and self exercise efficacy score of the experimental group were significantly increased, and the single exercise duration was longer, the difference was statistically significant (P<0.05) . The physiological function score, general health score, physical energy score, mental health score and total score of the experimental group were higher, and the differences were statistically significant (P<0.05) . Conclusion: CDSMP may have a certain effect in promoting lung rehabilitation in COPD patients.

Impact of the chronic disease self-management program (CDSMP) on self-perceived frailty condition: the EU-EFFICHRONIC project.

Introduction:The Chronic Disease Self-Management Program (CDSMP) improves self-efficacy and health outcomes in people with chronic diseases. In the context of the EFFICHRONIC project, we evaluated the efficacy of CDSMP in relieving frailty, as assessed by the self-administered version of Multidimensional Prognostic Index (SELFY-MPI), identifying also potential predictors of better response over 6-month follow-up.Methods:The SELFY-MPI explores mobility, basal and instrumental activities of daily living (Barthel mobility, ADL, IADL), cognition (Test Your Memory-TYM Test), nutrition (Mini Nutritional Assessment-Short Form-MNA-SF), comorbidities, medications, and socio-economic conditions (social-familiar evaluation scale-SFES). Participants were stratified in three groups according to the 6-month change of SELFY-MPI: those who improved after CDSMP (Δ SELFY-MPI < 0), those who remained unchanged (Δ SELFY-MPI = 0), and those who worsened (Δ SELFY-MPI > 0). Multivariable logistic regression was modeled to identify predictors of SELFY-MPI improvement.Results:Among 270 participants (mean age = 61.45 years, range = 26–93 years; females = 78.1%) a benefit from CDSMP intervention, in terms of decrease in the SELFY-MPI score, was observed in 32.6% of subjects. SELFY-MPI improvement was found in participants with higher number of comorbidities (1–2 chronic diseases: adjusted odd ratio (aOR)=2.38, 95% confidence interval (CI) =1.01, 5.58; ⩾ 3 chronic diseases: aOR = 3.34, 95% CI = 1.25, 8.90 vs no chronic disease), poorer cognitive performance (TYM ⩽ 42: aOR = 2.41, 95% CI = 1.12, 5.19 vs TYM > 42) or higher risk of malnutrition (MNA-SF ⩽ 11: aOR = 6.11, 95% CI = 3.15, 11.83 vs MNA-SF > 11).Conclusion:These findings suggest that the CDSMP intervention contributes to decreasing the self-perceived severity of frailty (SELFY-MPI score) in more vulnerable participants with several chronic diseases and lower cognitive performance and nutritional status.

Willingness to participate in adapted pain and disease self-management programs: evaluating preferences of Black men

Background and objective: The health of Black men continues to be a discussion of public health concern. To address this concern, this exploratory study aimed to assess Black men's willingness and preferences for participating in tailored pain and/or disease self-management programs. Materials and Methods: Three program designs were presented, with varying delivery modalities. Participants responded to a series of questions regarding the content and form of program implementation. A total of 75 Black men, with an average age of 57 (SD = 14.8) years, were included for study participation. Results: Responses to a set of closed- and open-ended questions showed that less than one-third (29.3%) had never heard of chronic disease self-management programs, with another 77.3% never participating in a self-management program. Overall, the majority of the men preferred receiving health information from books (73.3%) or brochures (74.7%). Few (15.0%) preferred receiving health advice from family. More than one-third however, preferred receiving information from friends (38.7%) or a religious leader (33.3%). Conclusion: Results from this study contribute to our understanding of how more effective programming and systems tailored to the health needs of this gendered population is needed in order to promote safe and cost-effective approaches to prevention and treatment efforts.

Amendments Made to the Older Americans Act Titles III, IV, and V

This presentation discusses amendments made to the Older Americans Act titles III, IV and V through the most recent reauthorization. Title III reauthorizes Title IV programs, Title IV reauthorizes title V programs and Title V reauthorizes title VI programs. The reauthorizations each include a seven percent increase in fiscal year 2020 and a six percent increase per year for the next four fiscal years. New in title III are an amendment that allows projects that address traumatic brain injury among older adults to be included in grant programs, an amendment that improves an existing transportation grant program and an amendment that improves an existing grant program for multigenerational collaboration. Additionally, existing falls prevention and chronic disease self-management programs are codified within title III. New in title IV is an amendment that allows eligible previously incarcerated individuals to be considered a prioritized population for the Senior Community Service Employment Program.

An interactive technology enhanced coaching intervention for Black women with hypertension: Randomized controlled trial study protocol.

In the United States, hypertension (HTN) is the leading risk factor for cardiovascular disease, and a more significant health problem for Blacks compared with other racial/ethnic groups. The prevalence of HTN in Black women is among the highest in the world, underscoring the need for effective prevention and management approaches for blood pressure (BP) control. We developed a two-arm randomized controlled trial repeated measures design study for improving HTN self-management among Black women. The study tests whether the Chronic Disease Self-Management Program (CDSMP) combined with interactive technology-enhanced coaching, can improve BP control and adherence to treatment (e.g., medication-taking, physical activity, calorie intake, and weight management) compared with the CDSMP alone. Repeated measurements were conducted at 3, 6, and 9 months. A sample of 90 community-dwelling Black women with uncontrolled Stage 1 HTN (BP ≥ 130/80) were enrolled, completed CDSMP training, and randomized. This study will contribute to our understanding of novel methods to empower Black women to increase their active involvement in self-care management of HTN.

Management Of Chronic Noncommunicable Diseases After Natural Disasters In The Caribbean: A Scoping Review.

Extreme weather events in the Caribbean region are becoming increasingly severe because of climate change. The region also has high rates of poorly controlled chronic noncommunicable diseases (NCDs), which were responsible for at least 30percent of deaths after two recent hurricanes. We conducted a scoping review of literature published between 1974 and 2020 to understand the burden and management of chronic NCDs in the Caribbean after natural disasters. Of the twenty-nine articles included in this review, most described experiences related to Hurricanes Dorian (2019) and Irma and Maria (2017) and the Haiti earthquake (2010). Challenges included access to medication, acute care services, and appropriate food, as well as communication difficulties and reliance on ad hoc volunteers and outside aid. Mitigating these challenges requires different approaches, including makeshift points of medication dispensing, disease surveillance systems, and chronic disease self-management education programs. Evidence is needed to inform policies to build resilient health systems and integrate NCD management into regional and national disaster preparedness and response plans.

Translating CDSMP to the Workplace: Results of the Live Healthy Work Healthy Program.

Report the results of a randomized, controlled trial of Live Healthy, Work Healthy (LHWH), a worksite translation of the Chronic Disease Self-Management Program (CDSMP). 14 worksites were randomly assigned to LHWH, standard CDSMP (usual care) or no-intervention (control) group. The diverse set of work organizations centered around a rural community in SE US. 411 participants completed baseline data with 359 being included in the final analyses. LHWH had been adapted to fit the unique characteristics of work organizations. This translated program consists of 15 sessions over 8 weeks and was facilitated by trained lay leaders. The primary outcomes including health risk, patient-provider communication, quality of life, medical adherence and work performance were collected pretest, posttest (6 mos.) and follow-up (12 mos.). Analyses were conducted using latent change score models in a structural equation modeling framework. 79% of participants reported at least one chronic condition with an average of 2.7 chronic conditions reported. Results indicated that LHWH program demonstrated positive changes in a most outcomes including significant exercise (uΔ = 0.89, p < .01), chronic disease self-efficacy (uΔ = 0.63, p < .05), fatigue (uΔ = -1.45, p < .05), stress (uΔ = -0.98, p < .01) and mentally unhealthy days (uΔ = -3.47, p < .001). The translation of LHWH is an effective, low cost, embeddable program that has the potential to improve the health and work life of employees.

Factors Associated With Participation in the Chronic Disease Self-Management Program: Findings From the SUCCEED Trial.

Self-management programs may improve quality of life and self-efficacy for stroke survivors, but participation is low. In a randomized controlled trial of a complex, multidisciplinary, team-based secondary stroke prevention intervention, we offered participants Chronic Disease Self-Management Program (CDSMP) workshops in addition to clinic visits and home visits. To enhance participation, workshops were facilitated by community health workers who were culturally and linguistically concordant with most participants and scheduled CDSMP sessions at convenient venues and times. Over time, we implemented additional strategies such as free transportation and financial incentives. In this study, we aimed to determine factors associated with CDSMP participation and attendance. From 2014 to 2018, 18 CDSMP workshop series were offered to 241 English and Spanish-speaking individuals (age ≥40 years) with recent stroke or transient ischemic attack. Zero-inflated Poisson regression was used to identify factors associated with participation and attendance (ie, number of sessions attended) in CDSMP. Missing values were imputed using multiple imputation methods. Nearly one-third (29%) of intervention subjects participated in CDSMP. Moderate disability and more clinic/home visits were associated with participation. Participants with higher numbers of clinic and home visits (incidence rate ratio [IRR], 1.06 [95% CI, 1.01-1.12]), severe (IRR, 2.34 [95% CI, 1.65-3.31]), and moderately severe disability (IRR, 1.55 [95% CI, 1.07-2.23]), and who enrolled later in the study (IRR, 1.12 [95% CI, 1.08-1.16]) attended more sessions. Individuals with higher chaos scores attended fewer sessions (IRR, 0.97 [95% CI, 0.95-0.99]). Less than one-third of subjects enrolled in the SUCCEED (Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities) intervention participated in CDSMP; however, participation improved as transportation and financial barriers were addressed. Strategies to address social determinants of health contributing to chaos and engage individuals in healthcare may facilitate attendance. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01763203.

Implementation of a self-management programme: recruitment strategies in five European countries

Abstract Introduction The Chronic Disease Self-Management Programme (CDSMP) has been successfully implemented in over 30 countries worldwide, demonstrating its effectiveness and cost savings to healthcare systems. The CDSMP aims at people with any chronic condition and caregivers, but it has not targeted specific vulnerable populations at different sites simultaneously. In this sense, this study presents the recruitment strategies to involve vulnerable populations in the CDSMP framed under the EU-funded project EFFICHRONIC (ref.: 738127). Methods The CDSMP was implemented in five countries (Spain, Italy, France, the Netherlands and the United Kinkdom) approaching several vulnerable target groups. The programme consists of strictly scripted group sessions during 6 weeks imparted by previously trained monitors. EFFICHRONIC recruitment was performed in 3 consecutive steps combining population-based and individual strategies: i) development of vulnerable maps to detect areas with higher vulnerability; ii) creation of alliances with different actors; and iii) identification of end-users. Results Over 234 leaders were trained distributed over the five sites and 237 workshops with end-users were organized following the recruitment strategies. The average number of engaged participants per workshop was 13. In total, 2,962 vulnerable persons were engaged and 2,177 finalized the programme, meaning a drop-out rate of 25%. The sample was composed of ethnic minorities, immigrants, refugees, older people living alone or in institutions, people with few economic resources or living in therapeutic communities, inmates and members of different kinds of associations. Discussion The strategic coordination at loco-regional level between multidisciplinary stakeholders has been a key success factor to obtain maximum recruitment. The activation of different strategies simultaneously optimized the project results approaching a wide variety of end-users and communities. Key messages Stakeholder engagement is crucial to identify and recruit vulnerable individuals in need of support for the management of their chronic conditions. Recruitment strategies must be adapted to each specific context and culture to achieve relevant adherence levels and benefits.

Leisure education in chronic disease self-management: a case study and lessons learned

ABSTRACT The number of individuals experiencing chronic conditions is on the rise, increasing the need for effective self-management strategies to promote their health and quality of life. This paper identifies how leisure education may complement and enhance skills considered necessary for appropriate self-management. To address this topic, detailed information about how leisure education was integrated into the existing Chronic Disease Self-Management Programme (CDSMP) is provided, including a discussion of how the content covered in this CDSMP + Leisure Education program was developed and examples of this curriculum. Lessons learned from this project are discussed, and future directions and suggestions for the inclusion of leisure education in other self-management programmes are considered.

The Effectiveness of a Chronic Disease Self-Management Program for Elderly People: a Systematic Review

Introduction: Elderly population is increasing in Pakistan. Majority of people aged 50 – 64, suffer from two or more chronic conditions. Care of elderly people is sub-optimal. Healthcare system has limited resources to provide healthcare support to elderly people. Thus, there is need to empower the elderly to self-manage their health conditions. Chronic Disease Self-Management Program (CDSMP) is the most widely accepted self-management patient education program. It is designed to help people to gain confidence and skills to better manage their chronic conditions. Evidence of the effectiveness of CDSMP specifically for elderly people aged 60 years and above is lacking. Therefore, the aim of this systematic review was to determine the effects of the program among chronically ill elderly people. Methods: MEDLINED, CINHAL, EMBASE, PSYINFO, JBI and ASSIA were searched between April and May, 2020 for studies that tested the effects of generic CDSMP. A total of 750 articles were identified, of which 5 were included in the core review (four randomized controlled trials and one quasi-experimental). Results: Eligible 5 studies yielded 2971 participants (mean aged 60.4 to 76.0 years). Elder people who participated in CDSMP improved their self-efficacy to manage disease in general and to manage symptoms. The effects on health status were mixed. Self-rated health and health distress showed significant improvement. Some health behaviours showed improvement, particularly exercise component showed significant improvement. For health services utilization, there was no improvement. Conclusion: The result of this review suggests that CDSMP is beneficial for elderly people who attended the structured CDSMP either through a trained care provider or layman. Experimental studies in low and middle income countries, with large sample sizes are suggested to further understand the impact of CDSMP.

Communication Cues and Engagement Behavior: Identifying Advertisement Strategies to Attract Middle-Aged Adults to a Study of the Chronic Disease Self-Management Program.

IntroductionLow- and middle-income, middle-aged adults have high rates of disease and death from chronic disease, yet their participation in self-management programs is low. This may be because advertisements for such programs often target elderly, predominantly white, affluent adults. Our study used data from a parent randomized controlled trial to identify theoretically driven advertisement cues to engage low- and middle-income, middle-aged adults in the Chronic Disease Self-Management Program (CDSMP).MethodsA framework that combined the Elaboration Likelihood Model and Protection Motivation Theory was used to guide χ2 and regression analyses to assess relationships between advertisement cue preferences and 5 stages of cognitive engagement (cue processing, cognitive appraisal of the advertised study, motivation to enroll) and behavioral engagement of study participants (enrollment and program participation).ResultsOne advertisement cue (taking control of one’s future) and 1 cue combination (financial security and taking control of one’s future) were significantly associated with study enrollment, as were motivation to enroll and cue processing.ConclusionThese results can inform CDSMP recruitment efforts to better engage low- and middle-income, middle-aged adults in an effort to mitigate the disproportionate burden of chronic disease in this population.

Overcoming barriers to recruitment and retention of African–American women with SLE in behavioural interventions: lessons learnt from the WELL study

BackgroundAfrican–Americans are historically under-represented in SLE studies and engaging them in behavioural interventions is challenging. The Women Empowered to Live with Lupus (WELL) study is a trial conducted to examine...

Exploring the Perceived Impact of the Chronic Disease Self-Management Program on Self-Management Behaviors among African American Women with Lupus: A Qualitative Study.

ObjectiveTo qualitatively explore the processes through which the Chronic Disease Self‐Management Program (CDSMP)—a peer‐led, group‐based educational intervention for people with chronic conditions—affects self‐management behaviors among African American women with systemic lupus erythematosus (SLE).MethodsUsing a longitudinal pre‐ and postintervention design, we conducted two waves of one‐on‐one, semistructured interviews with 24 purposefully sampled participants. Wave 1 interviews explored self‐management behaviors at baseline; wave 2 interviews focused on changes in these behaviors postintervention. Transcripts were analyzed using thematic analysis methods.ResultsStudy participants perceived the CDSMP to be a valuable resource that helped them improve fundamental self‐management behaviors, including exercise, relaxation, diet, and medication adherence. We found, with few exceptions, that in this sample, women's reported changes in self‐management behaviors did not vary by participant age, education, SLE disease severity, or depression status. Our analysis suggests that the CDSMP had the most widespread perceived effects on relaxation and exercise. Strategies that generated improvements in relaxation and exercise included goal setting, action planning, encouragement to pursue low‐impact physical activity, and introduction of mindfulness techniques to better manage SLE symptoms.ConclusionOur findings suggest that African American women with SLE perceived the CDSMP as an effective educational self‐management intervention. The program can potentially catalyze improvements in self‐management behaviors in this population, regardless of demographic or disease characteristics.

The Six-Month and One-Year Outcome of a Chronic Disease Self-Management Program Among Older Adults in Macao: A Quasi-Experimental Study.

IntroductionPromoting older adults to self-manage their chronic conditions is a major focus of the Macao government and healthcare professionals since more than 80% of older adults have suffered chronic conditions.ObjectivesThis study evaluated the effect of the Chronic Disease Self-management Program (CDSMP) on self-management behaviors, self-efficacy, health status, and healthcare services utilization among Macao older adults with chronic disease over six months, and assessed whether the intervention effect persisted for one year.MethodsA longitudinal and quasi-experimental design was used in this study. A total number of 158 older adults with at least one chronic disease were recruited from three Macao community centers. Participants in the study group engaged in a six-session CDSMP in the community centers and participants in the control group received usual care. The Chronic Disease Self-management Questionnaire was used to assess the outcome measures for baseline, six-month and one-year assessment.ResultsThe age of subjects ranged from 60 to 88, 64.6% had three or more chronic diseases. The results showed that the subjects in the study group had significant improvement in self-management behaviors, self-efficacy, and some health-related indicators at the point of six months, and these improvements were still observable at the point of one year when comparing to the control group. The results also showed that the study group had a decrease in healthcare services utilization, but there was no significant difference between the two groups.ConclusionThis study confirmed that the community-dwelling older adults in Macao can acquire positive outcomes in self-management and health-related indicators from the CDSMP. Hence, it is worth promoting this program as a health promotion activity in community.

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.