Understanding differences between caregivers and non-caregivers in completer rates of Chronic Disease Self-Management Program

Understanding barriers to participation in group chronic disease self-management (CDSM) programs: A scoping review

OBJECTIVE

To identify factors that influence enrollment in and attendance of chronic disease self-management (CDSM) group programs.

METHODS

A scoping review of peer-reviewed publications that reported on factors of enrollment or attendance in group CDSM programs for adults with any type of chronic condition. Screening was completed by two reviewers and data extraction was checked for accuracy. Data were summarized and key themes were identified in collaboration with the study team.

RESULTS

Following screening, 52 of 2774 articles were included. Attendance rates that varied from 10.4-98.5% (mean =72.5%). There is considerable overlap between enrollment and attendance factors. These included Competing Commitments, Logistics, Personal characteristics, Perception of illness/health status, Health service provision, and Group dynamics.

CONCLUSIONS

Varied and individualized factors can facilitate or impede enrollment or attendance in group CDSM programs. Consideration of these factors and tailoring of programs is needed to facilitate patient ability to take part. Participatory co-design is a growing approach to ensure programs meet individual and community needs. More research is needed to identify the specific impact of using codesign on enrollment and attendance in group CDSM programs.

PRACTICE IMPLICATIONS

Including community members and service users in design and implementation may enhance CDSM program access.

Attending with family members, completion rate and benefits accrued from chronic disease self-management program

OBJECTIVES

Chronic Disease Self-Management Program (CDSMP) has been demonstrated effective in addressing the self-management of chronic conditions among older adults. With a higher attrition rate, this study investigated whether attending with family members influenced completion of and benefits accrued from the CDSMP.

METHODS

The baseline data were collected from CDSMP participants in New York State (n = 4184), and the follow-up data were collected from completers (attended 4+ sessions) (n = 293). Multi-level logistic regression was employed to predict the association between family accompany and program completion. Paired sample t-test was used to compare the differences in benefits from CDSMP after six months.

RESULTS

Attending with family members was associated with a higher likelihood of completing the CDSMP (OR = 1.626, p < .05). All completers reported small but significant improvements in self-rated health at six months (p < .001), and the changes were greater for those with family members. Males, caregivers, those aged 65 to 84 years old, with college or above education, were more accompanied by family members. Workshops in senior centers, libraries, or educational institutions attracted more family companions.

DISCUSSION

Engaging family members may increase CDSMP participants' motivation to complete the program. CDSMP providers should encourage participants to attend with their family members.

Impact of the chronic disease self-management program (CDSMP) on self-perceived frailty condition: the EU-EFFICHRONIC project

Introduction:

The Chronic Disease Self-Management Program (CDSMP) improves self-efficacy and health outcomes in people with chronic diseases. In the context of the EFFICHRONIC project, we evaluated the efficacy of CDSMP in relieving frailty, as assessed by the self-administered version of Multidimensional Prognostic Index (SELFY-MPI), identifying also potential predictors of better response over 6-month follow-up.

Methods:

The SELFY-MPI explores mobility, basal and instrumental activities of daily living (Barthel mobility, ADL, IADL), cognition (Test Your Memory-TYM Test), nutrition (Mini Nutritional Assessment-Short Form-MNA-SF), comorbidities, medications, and socio-economic conditions (social-familiar evaluation scale-SFES). Participants were stratified in three groups according to the 6-month change of SELFY-MPI: those who improved after CDSMP (Δ SELFY-MPI < 0), those who remained unchanged (Δ SELFY-MPI = 0), and those who worsened (Δ SELFY-MPI > 0). Multivariable logistic regression was modeled to identify predictors of SELFY-MPI improvement.

Results:

Among 270 participants (mean age = 61.45 years, range = 26–93 years; females = 78.1%) a benefit from CDSMP intervention, in terms of decrease in the SELFY-MPI score, was observed in 32.6% of subjects. SELFY-MPI improvement was found in participants with higher number of comorbidities (1–2 chronic diseases: adjusted odd ratio (aOR)=2.38, 95% confidence interval (CI) =1.01, 5.58; ⩾ 3 chronic diseases: aOR = 3.34, 95% CI = 1.25, 8.90 vs no chronic disease), poorer cognitive performance (TYM ⩽ 42: aOR = 2.41, 95% CI = 1.12, 5.19 vs TYM > 42) or higher risk of malnutrition (MNA-SF ⩽ 11: aOR = 6.11, 95% CI = 3.15, 11.83 vs MNA-SF > 11).

Conclusion:

These findings suggest that the CDSMP intervention contributes to decreasing the self-perceived severity of frailty (SELFY-MPI score) in more vulnerable participants with several chronic diseases and lower cognitive performance and nutritional status.

Evaluation Design of EFFICHRONIC: The Chronic Disease Self-Management Programme (CDSMP) Intervention for Citizens with a Low Socioeconomic Position

Background/rationale: The Chronic Disease Self-Management Programme (CDSMP) intervention is an evidence-based program that aims to encourage citizens with a chronic condition, as well as their caregivers, to better manage and maintain their own health. CDSMP intervention is expected to achieve greater health gains in citizens with a low socioeconomic position (SEP), because citizens with a low SEP have fewer opportunities to adhere to a healthy lifestyle, more adverse chronic conditions and a poorer overall health compared to citizens with a higher SEP. In the EFFICHRONIC project, CDSMP intervention is offered specifically to adults with a chronic condition and a low SEP, as well as to their caregivers (target population). Study objective: The objective of our study is to evaluate the benefits of offering CDSMP intervention to the target population. Methods: A total of 2500 participants (500 in each study site) are recruited to receive the CDSMP intervention. The evaluation study has a pre-post design. Data will be collected from participants before the start of the intervention (baseline) and six months later (follow up). Benefits of the intervention include self-management in healthy lifestyle, depression, sleep and fatigue, medication adherence and health-related quality of life, health literacy, communication with healthcare professionals, prevalence of perceived medical errors and satisfaction with the intervention. The study further includes a preliminary cost-effectiveness analysis with a time horizon of six months. Conclusion: The EFFICHRONIC project will measure the effects of the CDSMP intervention on the target population and the societal cost savings in five European settings.