Factors Associated With Participation in the Chronic Disease Self-Management Program

Abstract

Background and Purpose: Self-management programs may improve quality of life and self-efficacy for stroke survivors, but participation is low. In a randomized controlled trial of a complex, multidisciplinary, team-based secondary stroke prevention intervention, we offered participants Chronic Disease Self-Management Program (CDSMP) workshops in addition to clinic visits and home visits. To enhance participation, workshops were facilitated by community health workers who were culturally and linguistically concordant with most participants and scheduled CDSMP sessions at convenient venues and times. Over time, we implemented additional strategies such as free transportation and financial incentives. In this study, we aimed to determine factors associated with CDSMP participation and attendance. Methods: From 2014 to 2018, 18 CDSMP workshop series were offered to 241 English and Spanish-speaking individuals (age ≥40 years) with recent stroke or transient ischemic attack. Zero-inflated Poisson regression was used to identify factors associated with participation and attendance (ie, number of sessions attended) in CDSMP. Missing values were imputed using multiple imputation methods. Results: Nearly one-third (29%) of intervention subjects participated in CDSMP. Moderate disability and more clinic/home visits were associated with participation. Participants with higher numbers of clinic and home visits (incidence rate ratio [IRR], 1.06 [95% CI, 1.01–1.12]), severe (IRR, 2.34 [95% CI, 1.65–3.31]), and moderately severe disability (IRR, 1.55 [95% CI, 1.07–2.23]), and who enrolled later in the study (IRR, 1.12 [95% CI, 1.08–1.16]) attended more sessions. Individuals with higher chaos scores attended fewer sessions (IRR, 0.97 [95% CI, 0.95–0.99]). Conclusions: Less than one-third of subjects enrolled in the SUCCEED (Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities) intervention participated in CDSMP; however, participation improved as transportation and financial barriers were addressed. Strategies to address social determinants of health contributing to chaos and engage individuals in healthcare may facilitate attendance. REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01763203.

Factors Associated With the Initiation and Retention of Patients With Lupus in the Chronic Disease Self‐Management Program

“…We found that initiation is subpar among women with children. This finding aligns with those of Lin et al who noted that although participants were intrinsically motivated to participate, external factors such as increased life chaos were associated with lower attendance (44). Life with children can be busy, and the schedules of parents may not permit the addition of a weekly commitment (44).…”

“…This finding aligns with those of Lin et al who noted that although participants were intrinsically motivated to participate, external factors such as increased life chaos were associated with lower attendance (44). Life with children can be busy, and the schedules of parents may not permit the addition of a weekly commitment (44). Future interventions can improve participation among those with children by making provision for child care either onsite or through renumeration for childminding services.…”

A systematic review of the mechanisms influencing engagement in diabetes prevention programmes for people with pre‐diabetes

“…Similar to the barriers in this review, participants reported difficulty affording transport to attend such lifestyle programmes and were unable to participate in programmes that required fees not covered by health insurance 123 . Further, chronic disease management programmes that offered incentives also found participants were more willing to engage and experienced improved health outcomes 124–126 . This review suggests that free/affordable programmes can alleviate the financial burden and provide equal opportunities for individuals, regardless of their financial situation to participate.…”

Effect of a Coordinated Community and Chronic Care Model Team Intervention vs Usual Care on Systolic Blood Pressure in Patients With Stroke or Transient Ischemic Attack

“…whereas those with higher chaos scores attended fewer sessions. 41 This suggests that addressing key social determinants of health may enhance participation.…”

“…We recently found that individuals with higher numbers of clinic and home visits, moderately severe disability, and later enrollment in the study (ie, after we began offering incentives and transportation) attended more CDSMP sessions, whereas those with higher chaos scores attended fewer sessions. 41 This suggests that addressing key social determinants of health may enhance participation.…”