The extent and breadth of benefits from participating in chronic disease self-management courses: A national patient-reported outcomes survey

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Abstract

Objective

To quantify the benefits that people receive from participating in self-management courses and identify subgroups that benefit most.

Methods

People with a wide range of chronic conditions attending self-management courses (N = 1341 individuals) were administered the Health Education Impact Questionnaire (heiQ). Baseline and follow-up data were collected resulting in 842 complete responses. Outcomes were categorized as substantial improvement (effect size, ES  0.5), minimal/no change (ES −0.49 to 0.49) and substantial decline (ES  −0.5).

Results

On average, one third of participants reported substantial benefits at the end of a course and this ranged from 49% in the heiQ subscale Skill and technique acquisition to 27% in the heiQ subscale Health service navigation. Stratification by gender, age and education showed that younger participants were more likely to benefit, particularly young women. No further subgroup differences were observed.

Conclusion

While the well-being of people with chronic diseases tends to decline, about one third of participants from a wide range of backgrounds show substantial improvements in a range of skills that enable them to self-manage.

Practice implications

These data support the application of self-management courses indicating that they are a useful adjunct to usual care for a modest proportion of attendees.

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.

References (44)

  • World Health Organization. Department of Chronic Diseases and Health Promotion (CHP). Available at:...
  • D. Lawrence

    Chronic disease care: rearranging the deck chairs

    Ann Intern Med

    (2005)
  • K. Lorig et al.

    The arthritis helpbook

    (2000)
  • K. Lorig et al.

    Living a healthy life with chronic conditions: self-management of heart disease, arthritis, diabetes, asthma, bronchitis, emphysema & others

    (2000)
  • Osteoporosis Victoria. The Osteoporosis Prevention and Self Management Course—leaders manual. Elsternwick: Osteoporosis...
  • Department of Health. The Expert Patient: A new approach to chronic disease management for the 21st Century. September...
  • National Health Service. Expert Patients Programme update. December 2005. Available at:...
  • Commonwealth Government Department of Health and Ageing. National evaluation of the Sharing Health Care Initiative:...
  • J. Chodosh et al.

    Meta-analysis: chronic disease self-management programs for older adults

    Ann Intern Med

    (2005)
  • A. Warsi et al.

    Arthritis self-management education programs: a meta-analysis of the effect on pain and disability

    Arthritis Rheum

    (2003)
  • K. Lorig et al.

    The chronic disease self-management program: leaders manual

    (1999)
  • K. Lorig et al.

    Outcomes of self-help education for patients with arthritis

    Arthritis Rheum

    (1985)
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