Background Given the potential value of self-management support programs for people with chronic diseases, it is vital to understand how they influence participants’ health attitudes and behaviours. The Stanford Chronic Disease Self-Management Program (CDSMP), the most well-known and widely studied such program, is funded in many provinces and jurisdictions throughout Canada. However, there is little published evidence on its impact in the Canadian health-care system. We studied participants’ reactions and perceived impacts of attending the Stanford program in one Ontario health region so we could assess its value to the health region. The study asked: What are participants’ reactions and perceived impacts of attending the Stanford CDSMP? Methods This mixed methods exploratory study held four focus groups approximately one year after participants attended a Stanford program workshop. At the beginning of each session, participants filled out a survey on the type and frequency of community and health resources used for their self-management. During the sessions, a moderator guided the discussion, asking about such things as long-term impact of the program on their lives and barriers to self-management of their chronic conditions. Results Participants perceived diverse effects of the workshop: from having a profound impact on one area to affecting all aspects of their lives. A change in physical activity patterns was the most prominent behaviour change, noted by over half the participants. Other recurrent effects included an improved sense of social connection and better coping skills. Barriers to self-management were experienced by almost all participants with several dominant themes emerging including problems with the health system and patient-physician interaction. Participants reported a wide variety of resources used in their self-management, and in some cases, an increase in use was noted for some resources. Conclusions Self-management support is, at its core, a complex and patient-centred concept, so a diversity of outcomes to match the diversity of participants should be expected. As these interventions move into different target populations and communities, it is essential that we continue to explore through multiple research methods, the effects, and their meaning to participants, ensuring the optimal investment of resources for the very individuals these interventions aim to serve.

Introduction The evidence supporting chronic disease self-management warrants further attention. Our aim was to identify existing policies, strategies and frameworks that support self-management initiatives. Methods This descriptive study was conducted as an environmental scan, consisting of an Internet search of government and other publicly available websites, and interviews with jurisdictional representatives identified through the Health Council of Canada and academic networking. Results We interviewed 16 representatives from all provinces and territories in Canada and found 30 publicly available and relevant provincial and national documents. Most provinces and territories have policies that incorporate aspects of chronic disease self-management. Alberta and British Columbia have the most detailed policies. Both feature primary care prominently and are not disease specific. Both also have provincial level implementation of chronic disease self-management programming. Canada's northern territories all lacked specific policies supporting chronic disease self-management despite a significant burden of disease. Conclusion Engaging patients in self-management of their chronic diseases is important and effective. Although most provinces and territories have policies that incorporate aspects of chronic disease self-management, they were often embedded within other initiatives and/or policy documents framed around specific diseases or populations. This approach could limit the potential reach and effect of self-management.

elf-management support (SMS) interventions are proliferating across Canada. They aim to decrease the growing burden of chronic diseases on individuals, families, communities and the health system. Their goal is empowered patients with the skills and confidence to better manage their conditions. 1 Many measures of effectiveness are used across SMS programs, 2 making comparisons difficult. Additionally, SMS is patient-centred and community-oriented, and must acknowledge the unique socioecological context in which disease management and support programs occur. 3 The purpose of this project was to determine how to improve evaluation of SMS in Canada to generate high-quality evidence to guide policy-makers, implementers, providers and participants. METHODSThis project used an iterative, multi-methods approach including scoping and focused literature reviews, internet scan, systematic review, interviews, a review of existing evaluation and chronic disease management frameworks, and a meeting of experts. The project was approved by the Ottawa Hospital Research Ethics Board. Scoping reviewA scoping review of the international literature identified the range of approaches to evaluation of SMS interventions. This review built on a 2008 systematic review 4 of chronic disease self-management interventions conducted by team members, searching multiple databases and grey literature sources for additional reports or discussions of evaluation methods until 2010. The scoping review methods are listed in Table 1. Seventy-eight studies or reports (see Supplemental Appendix A) met inclusion criteria, and evaluation methods and reported outcomes were identified for each of these. Systematic reviewA systematic review was conducted to identify SMS interventions reported for Canadian populations. Medline was used in order to capture the most mainstream articles from 2005 until July 7, 2012. The review methods are listed in Table 2.A total of 289 articles were returned by the search, after removing duplicates. Abstracts were reviewed to apply the inclusion and exclusion criteria and 20 articles received full review. Sixteen articles were included in a narrative synthesis of population, intervention, evaluation methods, and reported outcomes (see Supplemental Appendix B).

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