The extent and breadth of benefits from participating in chronic disease self-management courses: A national patient-reported outcomes survey
Introduction
Chronic diseases are an increasing burden for health care systems worldwide. The World Health Organization ascribes about 60% of global deaths and close to 50% of disability to chronic diseases [1]. It has become imperative to reduce this burden at the individual and societal levels as projections indicate that national health systems, in their current form, will not be able to cope [2]. One approach to reduce the burden associated with chronic conditions is the provision of group-based education and the active engagement of patients in their own care. Hence self-management courses have been developed to empower participants, increase their confidence, teach them skills and techniques and improve their interaction with the health care system to enable them to improve the management of their chronic condition [3].
In Australia, several formal courses for chronic disease self-management are offered through both government and non-government agencies. Such courses usually run 2–2.5 h per week over a 4–10 week period and are delivered in a group setting (8–15 participants). They are facilitated by lay leaders and/or health professionals who often use psycho-educational approaches to facilitate problem-solving, goal-setting, decision-making and individual action plans [3], [4], [5], [6].
A rapid growth in application of self-management courses has occurred in recent years. The UK National Health Service has implemented the Expert Patient Programme [7], a lay-led self-management intervention, as part of health care reform and about 31,000 patients have undertaken the program [8]. In the USA the chronic disease self-management program has been implemented within a large health care organisation [9]. Using a different approach, the Australian Commonwealth Department of Health and Ageing implemented the Sharing Health Care Initiative, which involved several large demonstration projects across a variety of settings [10].
As self-management courses are now being applied in a variety of settings and implemented at the government policy level, there is an urgent need to understand and document the impact of self-management courses across settings. Numerous controlled trials have been conducted across disease groups and have been summarised in meta-analytic and narrative reviews [3], [11], [12]. These studies, however, suggest that self-management courses might not be suitable for all types of chronic conditions and population subgroups.
In this paper, we investigate impacts of self-management courses undertaken across settings and demographic groups in Australia. Specifically, we set out to identify if gender, age and educational background are associated with lesser or greater benefits.
Section snippets
Courses and participants
From August 2004 to September 2005 a total of 142 self-management courses were evaluated. The types of courses included 94 chronic disease [13], 22 arthritis [14], 10 osteoporosis [6] and 16 other self-management courses. These were fibromyalgia, pulmonary/heart failure rehabilitation, pain and stress management courses.
For recruitment, all major providers of self-management courses across Australia were identified and contacted (including non-government organisations such as the Arthritis
Demographics
In total, 1341 individuals were identified in 142 courses. One thousand one hundred and sixty-nine participants entered the study. Of these, 842 (72%) individuals provided follow-up data.
Of the 1169 participants, 75% were female and the median age was 64 years (range from 18 to 92). Thirteen percent of participants had primary school or less education and about 15% had a university degree. Two thirds of participants reported they had at least one (31%) or two or more (36%) comorbidities apart
Discussion
A higher proportion of younger women reported benefits across most heiQ scales. The pattern in younger men was less clear and was limited to more practical concepts (health behaviours and skills). The absence of clear effects in men with regard to age group differences may be due to the small sample size. In general, younger people in our sample appear to have a greater capacity to benefit as they entered the courses with lower scores across all heiQ scales. These differences in baseline scores
Acknowledgments
Dr. Osborne's work was supported in part by the Baker Trust, Buckland Foundation, the Arthritis Foundation of Australia and the National Health and Medical Research Council Career Development Award (400391). The authors would also like to thank Amanda Springer, Dianne Ferguson and Luke Tellefson for data collection and management support as well as all participants who kindly took part in the study and the coordinators and course leaders who administered the questionnaires.
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