Efficacy of the Chronic Disease Self-Management Program in Urban, African American Older Adults

Molly Rose, PhD¹, Christine Arenson, MD², Pamela Harrod, MS², Robyn Salkey, MS², James Diamond, PhD², and Michael Rosenthal, MD². (1) JCHP School of Nursing, Thomas Jefferson University, Philadelphia, PA, USA, (2) JMC Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA, USA

Purpose: Older adults suffer a disproportionate share of chronic disease. Low income, minority elders are more likely to suffer excess morbidity and mortality from chronic diseases. The Chronic Disease Self-Management Program (CDSMP) has been shown to improve health behaviors and health status, and decrease health care utilization in relatively young, affluent, whites enrolled in an HMO. This one group pretest-posttest pilot study (conducted by a collaborative research team from nursing and family medicine) seeks to determine if the program is similarly efficacious in a low-income, urban, African American population. Methods: The intervention consists of a six week workshop, with 2.5 hour sessions weekly. The CDSMP has been developed and validated by Lorig, et. al. Based on self-efficacy theory, the standardized program uses two leaders (one health educator and one community lay leader), who have been trained and conduct sessions according to the leaders manual, previously adapted for African Americans. Subjects are recruited from senior centers, senior housing, and churches. Demographic, health status, health behaviors, self-efficacy, health utilization, and health beliefs are determined at baseline, 10 weeks and 6 months after the CDSMP. Results: As of July 2006, over 120 African American older adults will have completed the CDSMP. Significant changes between baseline and 10 weeks and 6 months on the stated outcome measures will be analyzed. Conclusions: Preliminary data suggest that the CDSMP delivered in community settings to low-income African American elders provides similar benefits as in majority, younger, affluent subjects. Elders report high levels of satisfaction with the program. CDSMP using community-based lay leaders and groups may result in health benefits in the short term. Lessons learned will be presented. Recommendations for future study include the need for randomized clinical trials over a longer time period and interventions to maintain quantitative and qualitative benefits achieved from the program.

Learning Objective #1: discuss the Chronic Disease Self-Management Program (intervention) theory and methods.
Learning Objective #2: relate the study outcome results and lessons learned for the study sample of urban, African American older adults.