Harvest Health: Translation of the Chronic Disease Self-Management Program for Older African Americans in a Senior Setting
Center for Applied Research on Aging and Health, Thomas Jefferson University, Philadelphia, PA 19107, USA. The Gerontologist
(Impact Factor: 3.21).
10/2008; 48(5):698-705. DOI: 10.1093/geront/48.5.698
We describe the translation of K. R. Lorig and colleagues' Chronic Disease Self-Management Program (CDSMP) for delivery in a senior center and evaluate pre-post benefits for African American participants.
Modifications to the CDSMP included a name change; an additional introductory session; and course augmentations involving culturally relevant foods, stress reduction techniques, and communicating with racially/ethnically diverse physicians. We recruited participants from senior center members, area churches, and word of mouth. We conducted baseline and 4-month post-interviews.
A total of 569 African American elders attended an introductory session, with 519 (91%) enrolling in the 6-session program. Of the 519, 444 (86%) completed >/=4 sessions and 414 (79%) completed pre-post interviews. We found small but statistically significant improvements for exercise (p =.001), use of cognitive management strategies (p =.001), energy/fatigue (p =.001), self-efficacy (p =.001), health distress (p =.001), and illness intrusiveness in different life domains (probabilities from.001-.021). We found no changes for health utilization. Outcomes did not differ by gender, number of sessions attended, number and type of chronic conditions, facilitator, leader, or recruitment site.
The CDSMP can be translated for delivery by trained senior center personnel to African American elders. Participant benefits compare favorably to original trial outcomes. The translated program is replicable and may help to address health disparities.
Available from: PubMed Central
- "Patients’ attendance rates were recorded each week. Adherence to the programme was considered to be attendance at four or more education sessions . "
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ABSTRACT: Standardised evidenced-based materials and mechanisms to facilitate the delivery of the education component of pulmonary rehabilitation are not widely available. The aims of this study were: 1) to adapt the self-management programme Living Well with COPD (LWWCOPD) programme, for embedding in pulmonary rehabilitation; and, 2) to conduct a process evaluation of the adapted programme.
The adaptations to the LWWCOPD programme were informed by focus groups, current practice, relevant research and guideline documents. Pulmonary rehabilitation sites used the adapted programme, the LWWCOPD programme for pulmonary rehabilitation, to deliver the education component of pulmonary rehabilitation. A process evaluation was conducted: elements included reach (patients' attendance rates), dose delivered (amount of programme delivered), dose received (health professional and patient satisfaction) and fidelity (impact on patients' knowledge, understanding and self-efficacy on the Understanding COPD questionnaire). Descriptive statistics (mean, SD) were used to summarise demographics and key data from the feedback questionnaires. Qualitative feedback on the programme was collated and categorised. Changes in the Understanding COPD questionnaire were examined using paired t-tests.
The LWWCOPD programme for pulmonary rehabilitation was delivered in eleven hospital- and community-based programmes (n=25 health professionals, n=57 patients with COPD). It consisted of six weekly 30--45 minute sessions. The process evaluation showed positive results: 62.3% of patients attended >= 4 education sessions (reach); mean (SD) 90 (10)% of the session content were delivered (dose delivered); the majority of sessions were rated as excellent or good by health professionals and patients. Patients' satisfaction was high: mean (SD) Section B of the Understanding COPD questionnaire: 91.67 (9.55)% (dose received). Knowledge, understanding and self-efficacy improved significantly: mean change (95% CI): Section A of the Understanding COPD questionnaire: 26.75 (21.74 to 31.76)%, BCKQ 10.64 (6.92 to 14.37)% (fidelity).
This rigorous process evaluation has demonstrated that the LWWCOPD programme for pulmonary rehabilitation can be used to deliver high quality, consistent and equitable education sessions during hospital and community-based pulmonary rehabilitation. This programme is now available worldwide (http://www.livingwellwithcopd.com/living-well-and-pulmonary-rehabilitation.html).Trial registration: This study was registered with clinicaltrials.gov (reference number: NCT01226836).
Available from: Aileen Davis
- "For example, Griffiths examined the Chronic Disease Self-Management Program and found an improvement in self-efficacy (effect size 0.67) . Gitlin found a 0.6 mean change in self-efficacy following a Chronic Disease Self-Management Program which was statistically significant and considered to be an improvement . While we don’t know if the increase in participants’ confidence to manage their condition will result in longer term change in outcomes, self-efficacy has been shown to relate to adaptive pain behaviours in arthritis . "
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Specially trained physiotherapists (advanced practice physiotherapists (APP)) are working in orthopaedic clinics to improve access to orthopaedic services and support chronic disease management. Little attention has been paid to the impact APPs may have on non-surgical patients. In non-surgical patients with hip or knee arthritis consulting an APP in an orthopaedic clinic, the objectives were to: 1) describe patients’ recall of APP recommendations, use of self-management strategies, and barriers to management six weeks following consultation; and, 2) compare exercise behaviour and self-efficacy at baseline and six weeks.
This was a single group pre-and post-intervention study of patients who saw an APP when consulting the orthopaedic departments of two hospitals. At baseline and six weeks participants completed the adapted Stanford Exercise Behaviour Scale (response options: none, < 60 minutes/week, 1–3 hours/week or > 3 hours/week), and the Chronic Disease Self-efficacy Scale (range 1–10; higher scores indicate higher self-efficacy). At follow-up participants completed questions on recall of APP recommendations, use of self-management strategies and barriers to management. Seventy three non-surgical patients with hip or knee arthritis participated, a response rate of 89% at follow-up. Seventy one percent of patients reported that the APP recommended exercise, of whom 83% reported exercising to manage their arthritis since the visit. Almost 50% reported an increase in time spent stretching; over 40% reported an increase in time spent walking or doing strengthening exercises at follow-up. Common barriers to arthritis management were time, cost and other health problems. Mean chronic disease self-efficacy scores significantly improved from 6.3 to 7.2 (p < 0.001). The mean difference was 0.95 (95% CI 0.43, 1.62); the effect size was 0.51.
This pilot study of an APP intervention for non-surgical patients referred for orthopaedic consultation showed promising results, particularly for enhancing use of conservative management strategies such as exercise.
Available from: Josiane J J Boyne
- "These moderate, short-term results among CHF patients as well as the inconsistent findings in previous CDSMP studies raise the issue whether the extent to which the programme is effective partly depends on patient characteristics. Although considerable research has been conducted on the effectiveness of the CDSMP, only a few studies explored the differential effects of patientrelated factors on programme outcomes      . In the present study, we aim to gain insight into which CHF patients benefited most from the programme in terms of cardiac-specific quality of life by conducting additional subgroup analyses. "
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ABSTRACT: The Chronic Disease Self-Management Programme (CDSMP)was recently evaluated among patients with congestive heart failure (CHF) in a randomized controlled trial (n = 317) with twelve months of follow-up after the start of the programme. That trial demonstrated short-term improvements in cardiac-specific quality of life. The current study assessed which of the patients participating in this trial benefited most from the CDSMP with respect to cardiac-specific quality of life.
Subgroup analyses were conducted using mixed-effects linear regression models to assess the relationship between patient characteristics and the effects of the CDSMP on cardiac-specific quality of life.
In the short term, patients with better cognitive status benefited more from the CDSMP than their poorer functioning counterparts. In addition, lower educated patients benefited more from the CDSMP than their higher educated counterparts during total follow-up.
Subgroup effects were found for cognitive status and educational level. Future research should be performed to validate current findings and further explore the conditions under which CHF patients may benefit more from the programme.
These results indicate that lower educated patients, in particular, should be encouraged to participate in the CDSMP. In addition, healthcare practitioners are recommended to take into account potential cognitive impairments of patients.
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