Brief Psychotherapy at the Bedside: Countering Demoralization From Medical Illness

Bedside psychotherapy with medically ill patients can help counter their demoralization, which is the despair, helplessness, and sense of isolation that many patients experience when affected by illness and its treatments. Demoralization can be usefully regarded as the compilation of different existential postures that position a patient to withdraw from the challenges of illness. A fruitful interviewing strategy is to discern which existential themes are of most concern, then to tailor questions and interventions to address those specific themes. Illustrative cases show how such focused interviewing can help patients cope assertively by mobilizing existential postures of resilience, such as hope, agency, and communion with others.

Normalization behaviours of rural fathers living with chronically-ill children: an Australian experience

This article reports findings from a larger qualitative study conducted to gain insight into the experience of fathers living with their chronically-ill children in rural Victoria, Australia. Data were collected via unstructured interviews with four fathers. The findings presented in this article explore the phenomena of normalization for fathers within the chronic illness experience. Fathers described normalizing the experience of living with their chronically-ill child as involving a combination of various coping strategies and behaviours including: (1) accepting the child's condition, (2) changing expectations, (3) focusing energies on a day-to-day basis, (4) minimizing knowledge-seeking behaviours, and (5) engaging in external distraction activities. Findings highlight the complex and unique normalization strategies these men utilized and contribute to knowledge and understanding of the complex nature of raising a chronically-ill child in rural Australia and provide a sound basis upon which to guide an ongoing and holistic assessment of fathers with chronically-ill children.

Chronic illness and depressive symptoms in late life

The relationship between illness and depressive symptoms is examined using a large, nationally representative, and longitudinal sample of Americans over the age of 50. Seven illnesses (cancer, stroke, heart condition, chronic obstructed pulmonary disease, diabetes, high blood pressure, and arthritis) and three forms of disability (activities in daily living, mobility, and strength) substantially increase symptoms. Yet, most of these positive effects diminish with age. Multiplicative interactions between age and illness indicate that those who develop chronic illnesses earlier in life tend to report more depressive symptoms than do those who develop them later. Similarly, disability leads to more depressive symptoms when experienced at younger ages. This age-graded effect emerges even for illnesses that are known to share a biological substrate with depression (e.g. vascular disorders). The results are discussed with respect to theories of illness, depression, and aging.

Is it beneficial to involve a family member? A meta-analysis of psychosocial interventions for chronic illness

Links between chronic illness and family relationships have led to psychosocial interventions targeted at the patient's closest family member or both patient and family member. The authors conducted a meta-analytic review of randomized studies comparing these interventions with usual medical care (k=70), focusing on patient outcomes (depression, anxiety, relationship satisfaction, disability, and mortality) and family member outcomes (depression, anxiety, relationship satisfaction, and caregiving burden). Among patients, interventions had positive effects on depression when the spouse was included and, in some cases, on mortality. Among family members, positive effects were found for caregiving burden, depression, and anxiety; these effects were strongest for nondementing illnesses and for interventions that targeted only the family member and that addressed relationship issues. Although statistically significant aggregate effects were found, they were generally small in magnitude. These findings provide guidance in developing future interventions in this area.

Role of religion and spirituality in medical patients: confirmatory results with the SpREUK questionnaire

BACKGROUND

Spirituality has become a subject of interest in health care as it is was recognized to have the potential to prevent, heal or cope with illness. There is less doubt that values and goals are important contributors to life satisfaction, physical and psychological health, and that goals are what gives meaning and purpose to people's lives. However, there is as yet but limited understanding of how patients themselves view the impact of spirituality on their health and well-being, and whether they are convinced that their illness may have "meaning" to them. To raise these questions and to more precisely survey the basic attitudes of patients with severe diseases towards spirituality/religiosity (SpR) and their adjustment to their illness, we developed the SpREUK questionnaire.

METHODS

In order to re-validate our previously described SpREUK instrument, reliability and factor analysis of the new inventory (Version 1.1) were performed according to the standard procedures. The test sample contained 257 German subjects (53.3 +/- 13.4 years) with cancer (51%), multiple sclerosis (24%), other chronic diseases (16%) and patients with acute diseases (7%).

RESULTS

As some items of the SpREUK construct require a positive attitude towards SpR, these items (item pool 2) were separated from the others (item pool 1). The reliability of the 15-item the construct derived from the item pool 1 respectively the 14-item construct which refers to the item pool 2 both had a good quality (Cronbach's alpha = 0.9065 resp. 0.9525). Factor analysis of item pool 1 resulted in a 3-factor solution (i.e. the 6-item sub-scale 1: "Search for meaningful support"; the 6-item sub-scale 2: "Positive interpretation of disease"; and the 3-item sub-scale 3: "Trust in external guidance") which explains 53.8% of variance. Factor analysis of item pool 2 pointed to a 2-factor solution (i.e. the 10-item sub-scale 4: "Support in relations with the External life through SpR" and the 4-item sub-scale 5: "Support of the Internality through SpR") which explains 58.8% of variance. Generally, women had significantly higher SpREUK scores than male patients. Univariate variance analyses revealed significant associations between the sub-scales and SpR attitude and the educational level.

CONCLUSIONS

The current re-evaluation of the SpREUK 1.1 questionnaire indicates that it is a reliable, valid measure of distinct topics of SpR that may be especially useful of assessing the role of SpR in health related research. The instrument appears to be a good choice for assessing a patients interest in spiritual concerns which is not biased for or against a particular religious commitment. Moreover it addresses the topic of "positive reinterpretation of disease" which seems to be of outstanding importance for patients with life-changing diseases.

Health-related quality of life (HRQL) scores reported from parents and their children with chronic illness differed depending on utility elicitation method

OBJECTIVE

To describe the relationship between health-related quality of life (HRQL) as measured by utility when elicited from parents and their children with chronic illness.

STUDY DESIGN AND SETTING

We enrolled families of children admitted for cancer chemotherapy and those attending outpatient rheumatology, hemophilia and bone marrow transplantation clinics. Children in grade 6 or higher were included. The child's HRQL was rated by parent and child using the Standard Gamble (SG), Visual Analogue Scale (VAS), Time Trade-Off (TTO), and Health Utilities Index Mark 2/3 (HUI2 and HUI3).

RESULTS

22 families were included. The mean parent SG was 0.92 +/- 0.09, which was similar to the mean SG elicited from their children of 0.92 +/- 0.10. The parent and child SG were moderately concordant (ICC=0.64, 95% CI=0.30, 0.83; P=.0005). In contrast, TTO scores were not concordant (ICC=0.14, 95% CI=-0.29, 0.53; P=.3), with parents (mean TTO=0.77 +/- 0.31) rating HRQL worse than children (mean TTO=0.92 +/- 0.11; P=.04). Similarly, the mean parent HUI2 of 0.82 +/- 0.22 was lower than the child HUI2 of 0.95 +/- 0.07; P=.02 and HUI2 were not concordant (ICC=0.11, 95% CI=-0.35, 0.53; P=.3) between parents and children.

CONCLUSION

Parents and children rate HRQL similarly according to SG, but parents rate HRQL significantly worse using TTO and HUI2.

Health-related stress, affect, and depressive symptoms experienced by caregiving mothers of adults with a developmental disability

The interrelationships among health-related stress, positive and negative affect, and depressive symptoms patterned in the dynamic model of affect (J. Reich, A. Zautra, & M. Davis, 2003) were examined using data from 932 women having an adult child with a developmental disability. Results indicate that women experience a moderate inverse correlation between positive and negative affect under conditions of low levels of health-related stress, whereas at high levels of stress, positive and negative affect become more strongly inversely correlated. Under high-stress conditions, both negative affect and positive affect have a stronger relationship to depressive symptoms than they do under low-stress conditions.

"It's always continuing": first-year medical students' perspectives on chronic illness and the care of chronically ill patients

PURPOSE

Caring for patients with chronic health conditions is an important component of health care in the 21st century. This study uses qualitative research methods to take an in-depth look at the attitudes of first-year medical students toward chronic illness and the care of chronically ill patients.

METHOD

In Spring 2000, 26 first-year medical students at the College of Human Medicine, Michigan State University, were invited to participate in interviews focused on their attitudes toward caring for patients with chronic illness. Transcripts of the interviews were analyzed to identify iterative themes. Concurrently, all 105 first-year students were given a questionnaire that asked about their attitudes toward various aspects of patient care.

RESULTS

Nineteen students participated in the interviews. Students viewed chronic illness as incurable, long running, life altering, and often terminal. Most students had firsthand experience with chronic illness in family members; many had premedical work experience with chronically ill patients. Most students described themselves as comfortable with a partnership relationship with patients. Students acknowledged responsibility for caring for those with chronic illness but anticipated sadness and frustration in this work. One hundred and four students completed the questionnaire. Respondents' attitudes were consistent with those expressed in the interviews, suggesting that the interview findings represent the class as a whole.

CONCLUSION

Students enter medical school with complex attitudes toward chronic illness, many of which are more negative than previously reported. Qualitative instruments constitute important methods for studying the intricacies of students' attitudes and outlooks.

Relationships between perceived stress, coping behavior and cortisol secretion in women with high and low levels of internalized racism

AIM

It is hypothesized that a chronic defeat response to social or environmental stressors increases the likelihood of dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis with dysregulation of cortisol, accumulation of abdominal fat and development of glucose intolerance. Recent studies show that African-Caribbean women who have a high level of internalized racism (INR) are at increased risk for abdominal obesity and glucose intolerance. The aim of the current study was to determine if African-Caribbean women with high and low INR differ in their levels of perceived stress and defeat coping style, and in the relationship of these factors to cortisol secretion.

METHODS

On the island of Dominica, information on perceived stress and coping style was collected from age- and body mass index-matched samples of nondiabetic women aged 25-60 with high (n = 27) and low (n = 26) INR. Cortisol levels for each participant were determined from saliva specimens collected at 8:30 am and 10:30 pm.

RESULTS

A higher mean perceived stress score (PSS) and greater tendency to use "restraint," "denial" and "behavioral disengagement" (defeated) coping (BDC) styles were found among women with high INR compared to those with low INR. In the combined sample, PSS and BDC were significantly correlated with an indicator of dysregulation of cortisol. However, in group-specific analyses, adjusting for age and education, these correlations remained significant only among women with high INR.

CONCLUSION

These findings support the view that high perceived stress and defeated coping style may be factors that link high INR to dysregulation of cortisol and, perhaps, also to greater risk of metabolic abnormalities.

The search for social safety and comfort in families raising children with complex chronic conditions

Social consequences of raising children who were medically fragile and developmentally delayed (MF/DD) were explored in an ethnographic study of 20 families with school-age children. The overarching theme was the families' search for safety and comfort in social situations. Major categories comprising this theme included the need to anticipate and plan for the child's care; overcoming environmental, child-related, and attitudinal barriers; and finding social activities that were comfortable for all members of the family. When this search was successful, families could relax, and all members could participate in a variety of social encounters and activities; but when safety and comfort could not be achieved, families were likely to limit social activities or split the family so that the child who was MF/DD could be cared for while other family members participated in social events.

Uncovering the limits of patient-centeredness: implementing a self-management trial for chronic illness

Research evaluating self-management of chronic conditions points to the effectiveness of interventions' changing the health behavior of individuals. However, we know little about how self-management is negotiated within health services. The authors designed a qualitative investigation to illuminate the quantitative findings of a randomized controlled trial (RCT) of a self-management program for people with inflammatory bowel disease. They conducted in-depth interviews with physicians and patients, and qualitative analysis illuminated the nature of doctor-patient encounters and possible reasons for lack of change in patient satisfaction with the consultation. The findings suggest that factors inhibiting effective patient-centered consultations include failure of physicians to incorporate expressed need relevant to people's self-management activities fully, interpretation of self-management as compliance with medical instructions, and the organization of outpatients' clinics. Giving attention to these barriers might maximize the opportunities for patient self-management of chronic illness based on a therapeutic alliance with health care professionals.

Changes in the neuropsychological correlates of clinical dimensions between the acute and stable phase of schizophrenia

This study was designed to investigate whether the neuropsychological correlates of the symptom dimensions of schizophrenia vary with the clinical state in patients followed from the acute to stable the phase of the illness. Fifteen patients were assessed for symptoms (SAPS-SANS) and undergone a complete neuropsychological assessment at two sessions. The first session (S1) was carried out within six days after admission, i.e., acute phase and the second (S2) at least two month after hospitalization, i.e., stable phase. The data were analyzed using stepwise regression models in which neuropsychological scores were in entered to predict each dimensional score. This analysis was applied on the S1 and S2 data as well as on the S2-S1 difference to assess the neuropsychological predictors of clinical changes. Generally, the results replicate the previous associations between neuropsychological and dimensional measures found in stable patients. In addition, this study shows if each dimension appears to rely on a key structure, symptom variations seems to involve changes in the spread of the dysfunction and/or changes in the connectivity between the key and other regions. The results also suggest that functional changes related to some symptoms dimensions occur to compensate for the dysfunction associated with other symptoms.

Enfrentamento de situações adversas e favoráveis por pessoas idosas em condições crônicas de saúde

Investigar as situações adversas e favoráveis vivenciadas por pessoas idosas em condições crônicas de saúde, e as estratégias de enfrentamento, foi o objetivo deste estudo. A amostra constou de 18 idosos e as informações foram obtidas por entrevistas com questões abertas. Para a análise, utilizou-se a técnica do Discurso do Sujeito Coletivo. Os resultados mostraram que a morte e a separação de familiares foram vistas como as mais significantes situações adversas. As situações favoráveis incluíram a família, sabedoria, experiência, aposentadoria e a vida em si. O enfrentamento se apresentou focalizado no problema e na emoção. O enfrentamento focalizado na emoção se caracterizou pelo sentimento de fé, pelo trabalho, pela busca de ajuda da família e de outras pessoas significantes, pela participação em grupo de idosos e pela rejeição às perdas naturais relacionadas ao envelhecimento. O enfrentamento, focalizado no problema, foi representado pela busca do atendimento médico e cuidado do corpo, numa tentativa de minimizar os problemas.

Comorbidity of chronic diseases

Although much research has been done on the impact of chronic illness on quality of life, still relatively little is known about the role of comorbidity. Given the growing number of (older) people with multiple chronic conditions, more information is needed on the effects of specific disease combinations for preventive purposes. In a nationwide representative sample of 1673 non-institutionalized chronic disease patients (recruited in 56 general practices) in The Netherlands, we assessed the separate and joint effects of cardiovascular disease, cancer, arthritis, chronic respiratory disease, diabetes mellitus, and thyroid dysfunction on physical and mental functioning. Data on medical diagnoses were provided by the general practitioners; data on physical and mental functioning were collected by a patient survey (SF-36). Compared to reference data of the general population, physical functioning appeared to be worse in all six diagnostic groups, whereas mental functioning was more or less comparable. Patients with arthritis or those suffering from comorbidity reported the lowest levels of physical functioning. Synergistic effects of combinations of diabetes, cardiovascular disease and/or chronic respiratory disease were found, indicating that patients suffering from these disease combinations run a higher risk of physical disability than could be expected from their separate effects.

The impact of considering adaptation in health state valuation

Patients with chronic health conditions often rate their quality of life (QoL) significantly higher than non-patients. One explanation for this discrepancy is that non-patients focus on the negative aspects of the onset of a condition, especially the early difficulties people face when they first experience a debilitating condition, without considering that patients can adapt to it over time. To test this hypothesis, we had 359 people perform person tradeoff (PTO) elicitations in an online survey, varying whether the treatment programs under consideration saved the lives of patients (a) with pre-existing paraplegia; or (b) who would experience new onset of paraplegia. Half of each group completed an "adaptation exercise" which encouraged them to consider their own ability to emotionally adapt to negative events in general and specifically to having paraplegia. The adaptation manipulation increased the value participants placed on pre-existing paraplegia (p=0.03) and on new onset paraplegia (p=0.05), relative to saving healthy lives. Moreover, the adaptation exercise dramatically reduced the differences between evaluations of pre-existing and new onset paraplegia to values within 2% of each other. Our findings suggest that asking non-patients to do an adaptation exercise before giving QoL ratings may help close the gap in ratings between patients and citizen non-patients.

Support network of adolescents with chronic disease: adolescents' perspective

The purpose of this study was to describe the support network of adolescents with a chronic disease from their own perspective. Data were collected by interviewing adolescents with asthma, epilepsy, juvenile rheumatoid arthritis (JRA) and insulin-dependent diabetes mellitus (IDDM). The sample consisted of 40 adolescents aged between 13 and 17 years. Interview data were examined using content analysis. Six main categories were established to describe the support network of adolescents with a chronic disease: parents, peers, school, health care providers, technology and pets. Peers were divided into two groups: fellow sufferers and peers without a chronic disease. At school, teachers, school nurses and classmates were part of the support network. Health care providers included nurses, physicians and physiotherapists. Technology was also part of the support network and included four techniques that may be used to communicate: computers, mobile telephones, television and videos. The results provided a useful insight into the social network of adolescents with chronic disease and serve to raise awareness of the problems and opinions experienced by adolescents with this condition.

The role of psychosocial factors in explaining socio-economic differences in mobility decline in a chronically ill population: results from the GLOBE study

In chronically ill patients, mobility develops more unfavorably in persons with low socio-economic status (SES) than in their better-off counterparts. Using longitudinal data from the Dutch GLOBE study (a study of health and living conditions in Eindhoven and its surroundings), the present study examines whether psychosocial factors can explain socio-economic differences in mobility decline, independent of disease severity, co-morbidity, and health-related behavior in a chronically ill population. Data were from 1384 men and woman, aged 15-74 years, suffering from at least one of the four chronic diseases: asthma/COPD, heart disease, diabetes mellitus, and low back pain. Three indicators of SES were used: education, occupational class, and income. Change in physical mobility between 1991 and 1997 was measured with the Nottingham Health Profile (NHP). Psychosocial factors were measured extensively and included life events, long-term difficulties, coping styles, social support, and personality characteristics. Low occupational level and low income predicted an increased risk of mobility decline in comparison to people with a higher occupational level and income, even after controlling for sociodemographics, disease severity, co-morbidity, and health-related behavior. Additional adjustment for psychosocial factors hardly reduced the SES-related odds ratios of mobility decline. We conclude that psychosocial factors (and also health-related behaviors, disease severity and co-morbidity) cannot explain socio-economic differences in mobility decline in a chronically ill population. Our findings will not give us new tools for prevention and intervention strategies in order to reduce physical disability and particularly the SES differences therein.

Self-valuation and societal valuations of health state differ with disease severity in chronic and disabling conditions

OBJECTIVES

We sought to determine the relationship between self-reported ratings of health-related quality of life (HRQoL) by people with 3 chronic and disabling conditions and population estimates of those health states and to model factors that might explain the disagreement between these 2 ratings.

RESEARCH DESIGN

A cross-sectional postal survey was sent in which each participant completed a set of questionnaires addressing HRQoL. Data from self-valuation on a visual analog scale (VAS) was compared with a population-based VAS-equivalent valuation, using the EQ-5D instrument. Different ways of scaling the 2 VAS scores were also explored. Data were analyzed using descriptive statistics and analysis of covariance.

SUBJECTS

A community sample of 1036 people took part in the study (rheumatoid arthritis n = 142, stroke n = 585, multiple sclerosis n = 309). MEASUREMENT INSTRUMENT: The EQ-5D health state profile and accompanying visual analog scale were used.

RESULTS

Self-ratings were significantly different than the population-based ratings, and agreement was poor, both on the original scale of the data and by analyses of rescaled data. On the original scales the mean difference was 0.13 (95% confidence interval 0.117-0.143). Diagnosis, health state severity, and its square explained 35.3% of the variation in the differences between self and population ratings with a curvilinear relationship suggesting that the differences increased as the health state worsened, but at a decreasing rate as health state severity increased.

CONCLUSIONS

This study provides evidence that EQ-5D population valuation estimates of treatment benefit for people with disabling and chronic conditions may well be inaccurate representations of the degree of change actually experienced by the individual with the condition. The varying magnitude of difference between the 2 forms of valuation has important implications for interpreting shifts in health status valuation following interventions for these populations.

Chronic ultra-mild stress improves locomotor performance of B6D2F1 mice in a motor risk situation

Chronic low grade stress predispose to psychopathological disorders. We consistently showed that chronic ultra-mild stress (CUMS) applied to B6D2F1 female mice induced behavioral disinhibition in several conflict exploration models. Insufficient reactivity to conflicts may be maladaptive and lead to inappropriate appreciation of potential risks and impaired ability to cope with those. Therefore, the purpose of the study was to assess the effect of a CUMS procedure on the behavior of mice in a motor risk situation based on multisensory conflict. Following three weeks exposure to various mild stressors, stressed and control B6D2F1 mice were tested on the rotating beam to determine how CUMS exposure affected balance control, posture stability and locomotor performance in response to a sensory-motor challenge. Detailed behavioral analysis included several parameters, both postural (height of the trunk, tail angle, number of imbalances, falls and head movements) and kinetic (mean velocity on the beam, distance covered with large and small movements, plus time spent in no-motion episodes). Comparisons between control and stressed mice showed that CUMS exposure increased mean velocity and improved locomotor performance in the learning task. In addition, sensitivity to sensory conflict seemed to be reduced in stressed mice, which displayed fewer behavioral adjustments to the increasing difficulty of the test compared to control mice. The results are discussed in terms of the possible influence of disturbances in behavioral and attentional inhibitory processes following CUMS exposure. Whether longer periods of CUMS exposure would shift the performance on the RTB from improvement to deterioration remain to be established.

Susceptibility to subchronic unpredictable stress is related to individual reactivity to threat stimuli in mice

As in many complex behavioral responses, inter-individual variability can be observed in the responses to a chronic mild stress. While some subjects exhibit more resilient behaviours, others appear more susceptible to stress. This study hypothesizes that this variability relies on the individual appraisal of the stressful event. To study this assumption, mice were first subjected to a conditioned task occurring in a circular arena. In this task, a mild air-puff (i.e. stressor) in a given quadrant of the arena was coupled with the presence or the absence of a light in the same quadrant. Half of mice were then submitted to a 15-day subchronic stress consisting in various environmental and social mild stressors randomly applied two or three times a day. At the end of this procedure, the occurrence of depressive-like behaviours in stressed mice was assessed using measures of the stress regime (i.e. physical state, choice test, grooming test). The physical state assessed the physical appearance of mice. The grooming test consisted in measuring the time spent in grooming after mice were sprayed upon with a viscous solution. The choice test consisted in measuring the time spent in an uncomfortable place (i.e. whose floor was covered with damp sawdust) versus a more comfortable one (i.e. with dry sawdust) to evaluate the reactivity to a negative stimulus previously encountered during the subchronic stress. Multiple regression analyses revealed a relationship between attention toward salient stressful stimuli in the conditioned task and susceptibility to the subchronic stress procedure. These results are discussed regarding their relevance for the understanding of aetiologies of depressive illnesses.

The impact of diabetes mellitus and other chronic medical conditions on health-related Quality of Life: is the whole greater than the sum of its parts?

BACKGROUND

Diabetes mellitus (DM) is an important public health concern, the impact of which is increased by the high prevalence of co-existing chronic medical conditions among subjects with DM. The aims of this study were therefore to (1) evaluate the impact of DM and co-existing chronic medical conditions on health-related quality of life (HRQoL) (which could be additive, synergistic or subtractive); (2) to determine the extent to which the SF-6D (a single-index preference measure) captures the multidimensional information provided by the SF-36 (a profile measure).

METHODS

Using data from a cross-sectional, population-based survey of Chinese, Malay and Indians in Singapore, we developed 9 separate multiple linear regression models, with each SF-36 scale or SF-6D index score being the dependent variable for one model. The influence of DM and a second chronic medical condition (hypertension (HTN), heart disease (HD), musculoskeletal illnesses (MS)) and their interactions were studied after adjusting for the influence of potential confounding variables.

RESULTS

Among 5,224 subjects, the prevalence of DM, HTN, HD and MS were 5.9%, 10.7%, 2.4% and 26.6% respectively. DM lowered SF-36 scores by more than 2 points on 3 SF-36 scales and lowered SF-6D scores by 0.03 points. Subjects with DM and HTN, DM and HD or DM and MS experienced further lowering of SF-36 scores exceeding 2 points on at least 6 scales and further lowering of SF-6D scores by 0.05, 0.08 and 0.10 points respectively. Generally, DM and co-existing medical conditions exerted additive effects on HRQoL, with the exception of DM and heart disease, where a subtractive effect was noted. SF-6D index scores generally reflected the patterns of influence of DM and chronic medical conditions on SF-36 scores.

CONCLUSION

DM and chronic medical conditions generally reduced HRQoL in this multiethnic general population in an additive, rather than synergistic or subtractive fashion. In this study, the SF-6D was a reasonably good summary measure for the SF-36.

Chronic disease self-management improved with enhanced self-efficacy

This pilot study used a quasi-experimental pretest-posttest design to examine if participation in a chronic disease self-management program (CDSMP) improved self-efficacy, self-efficacy health, and self-management behaviors in an underserved, poor, rural population. The sample, recruited from two clinics in a south central state, consisted of 48 adults (59.70 +/- 11.22 years) and was 79.2% Caucasian (n = 38) and 20.8% (n = 10) African American. Trained lay leaders with chronic illnesses directed the interactive CDSMP based on Bandura's self-efficacy theory that included strategies for personal exercise program development, cognitive symptom management, problem solving, and communication skills. Program-specific paper-and-pencil instruments were completed prior to and immediately after completion of the 6-week program. Significant improvements (p <.10) in self-efficacy, self-efficacy health, and self-management behaviors occurred. Results underscore the need to evaluate intervention programs for specific populations and for a new paradigm that focuses on patient-provider partnerships that can improve health outcomes in underserved, poor, rural populations.