Virginia M. Gonzalez

EVIDENCE SUGGESTING THAT A CHRONIC DISEASE SELF-MANAGEMENT PROGRAM CAN IMPROVE HEALTH STATUS WHILE REDUCING HOSPITALIZATION: A RANDOMIZED TRIAL

OBJECTIVES This study evaluated the effectiveness (changes in health behaviors, health status, and health service utilization) of a self-management program for chronic disease designed for use with a heterogeneous group of chronic disease patients. It also explored the differential effectiveness of the intervention for subjects with specific diseases and comorbidities. METHODS The study was a six-month randomized, controlled trial at community-based sites comparing treatment subjects with wait-list control subjects. Participants were 952 patients 40 years of age or older with a physician-confirmed diagnosis of heart disease, lung disease, stroke, or arthritis. Health behaviors, health status, and health service utilization, as determined by mailed, self-administered questionnaires, were measured. RESULTS Treatment subjects, when compared with control subjects, demonstrated improvements at 6 months in weekly minutes of exercise, frequency of cognitive symptom management, communication with physicians, self-reported health, health distress, fatigue, disability, and social/role activities limitations. They also had fewer hospitalizations and days in the hospital. No differences were found in pain/physical discomfort, shortness of breath, or psychological well-being. CONCLUSIONS An intervention designed specifically to meet the needs of a heterogeneous group of chronic disease patients, including those with comorbid conditions, was feasible and beneficial beyond usual care in terms of improved health behaviors and health status. It also resulted in fewer hospitalizations and days of hospitalization.

Chronic disease self-management program: 2-year health status and health care utilization outcomes.

Objectives.To assess the 1- and 2-year health status, health care utilization and self-efficacy outcomes for the Chronic Disease Self-Management Program (CDSMP). The major hypothesis is that during the 2-year period CDSMP participants will experience improvements or less deterioration than expected in health status and reductions in health care utilization. Design.Longitudinal design as follow-up to a randomized trial. Setting.Community. Participants.Eight hundred thirty-one participants 40 years and older with heart disease, lung disease, stroke, or arthritis participated in the CDSMP. At 1- and 2-year intervals respectively 82% and 76% of eligible participants completed data. Main Outcome Measures. Health status (self-rated health, disability, social/role activities limitations, energy/fatigue, and health distress), health care utilization (ER/outpatient visits, times hospitalized, and days in hospital), and perceived self-efficacy were measured. Main Results. Compared with baseline for each of the 2 years, ER/outpatient visits and health distress were reduced (P <0.05). Self-efficacy improved (P <0.05). The rate of increase is that which is expected in 1 year. There were no other significant changes. Conclusions.A low-cost program for promoting health self-management can improve elements of health status while reducing health care costs in populations with diverse chronic diseases.

Hispanic Chronic Disease Self-Management A Randomized Community-Based Outcome Trial

BackgroundIn light of health disparities and the growing prevalence of chronic disease, there is a need for community-based interventions that improve health behaviors and health status. These interventions should be based on existing theory. ObjectiveThis study aimed to evaluate the health and utilization outcomes of a 6-week community-based program for Spanish speakers with heart disease, lung disease, or type 2 diabetes. MethodThe treatment participants in this study (n = 327) took a 6-week peer-led program. At 4 months, they were compared with randomized wait-list control subjects (n = 224) using analyses of covariance. The outcomes for all the treatment participants were assessed at 1 year, as compared with baseline scores (n = 271) using t-tests. ResultsAt 4 months, the participants, as compared with usual-care control subjects, demonstrated improved health status, health behavior, and self-efficacy, as well as fewer emergency room visits (p < .05). At 1 year, the improvements were maintained and remained significantly different from baseline condition. ConclusionsThis community-based program has the potential to improve the lives of Hispanics with chronic illness while reducing emergency room use.

A randomized trial of a lay person-led self-management group intervention for back pain patients in primary care.

Study Design. Randomized, controlled trial. Objective. To evaluate a four‐session self‐management group intervention for patients with pain in primary care, led by trained lay persons with back pain. The intervention was designed to reduce patient worries, encourage self‐care, and reduce activity limitations. Background Data. Randomized trials of educational interventions suggest that activating interventions may improve back pain outcomes. Expert opinion increasingly regards effective self‐management of back pain as important in achieving good outcomes. In this study, an educational intervention designed to activate patients and support effective self‐management was evaluated. Methods. Six to 8 weeks after a primary care visit for back pain, patients were invited to participate in an educational program to improve back pain self‐management. Those showing interest by returning a brief questionnaire became eligible for the study. Participants (n = −255) randomly were assigned to either a self‐management group intervention or to a usual care control group. The effect of the intervention, relative to usual care, was assessed 3, 6, and 12 months after randomization, controlling for baseline values. The intervention consisted of a four‐session group applying problem‐solving techniques to back pain self‐management, supplemented by educational materials (book and videos) supporting active management of back pain. The groups were led by lay persons trained to implement a fully structured group protocol. The control group received usual care, supplemented by a book on back pain care. Results. Participants randomly assigned to the self‐management groups reported significantly less worry about back pain and expressed more confidence in self‐care. Roland Disability Questionnaire Scores were significantly lower among participants in the self‐management groups relative to the usual care controls at 6 months (P = 0.007), and this difference was sustained at 12 months at borderline significance levels (P = 0.09). Among self‐management group participants, 48% showed a 50% or greater reduction in Roland Disability Questionnaire Score at 6 months, compared with 33% among the usual care controls. Conclusions. Self‐management groups led by trained lay persons following a structured protocol were more effective than usual care in reducing worries, producing positive attitudes toward self‐care, and reducing activity limitations among patients with back pain in primary care.

Arthritis patient education: A review of the literature

Arthritis is one of the most prevalent chronic diseases and the number one disabler of the elderly. Even though arthritis is a major cause of morbidity and a contributor to early mortality, relatively few studies have been undertaken to examine effects of arthritis patient education. This review was undertaken to (1) provide a summary of arthritis patient education studies, (2) summarize the effectiveness of arthritis patient education in changing knowledge, behavior, psychological status, and health status, (3) address critical issues/problems in arthritis patient education study methodology, and (4) suggest guidelines for future design, implementation, and evaluation of arthritis patient education programs. In addition, we discuss implications of past studies for future practice.

Community-based Spanish language arthritis education program: a randomized trial.

OBJECTIVES To determine 4-month and 1-year health-related outcomes of a 6-week, lay-led, and community-based arthritis self-management program for Spanish-speaking participants and to determine the role of self-efficacy in predicting health status for this population. METHODS Three hundred and thirty one subjects were randomized to the program or to a 4-month wait list control group. One hundred ninety eight subjects continued in a 1-year longitudinal study. Data were collected via mailed questionnaires with telephone follow up. RESULTS At 4 months, treatment subjects, compared with controls, demonstrated positive changes in exercise, disability, pain, and self-efficacy (P < 0.05). At 1 year, compared with baseline, treatment subjects demonstrated improvements in exercise, general health, disability, pain, self-efficacy, and depression (P < 0.05). Baseline and 4-month changes in self-efficacy predicted health status at 1 year. CONCLUSIONS Spanish-speaking participants of an arthritis self-management program demonstrate short- and long-term benefits (improved health behaviors, health status, and self-efficacy).

The Integration of Theory with Practice: A 12-Year Case Study

Although the integration of health education theory with practice has always been taught, this linkage has not always occurred as a systematic part of program or theory development. This paper reflects the 12-year experience of one health education program which started from a base not soundly grounded in theory and moved to one tightly linked with theory. Throughout this process, outcome data were collected allowing for evaluations of both practice and theory.

Initial Validation of a Scale Measuring Self-Efficacy of Breast Self-Examination among Low-Income Mexican American Women

This paper presents the initial validation of a bilingual (English/Spanish) scale designed to assess intensity of perceived self-efficacy for breast self-examination (BSE) among low-income Mexican American women. The validation and reliability analysis included the use of Cronbachs alpha, factor analysis, and correlations of the measure with knowledge of correct BSE procedure, current level of breast self-examination, and English language proficiency. Cronbach s alpha coefficient demonstrated the reliability (internal consistency) of the scale. Results of the factor analysis supported the construct validity of the perceived self-efficacy measure, and statistically significant correlations with knowledge of correct breast self-examination, frequency of breast self-examination, and English language proficiency substantiate the concurrent validity of the measure. Further testing of the scale is proposed to strengthen the validity of the concept of self-efficacy and its measure.