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Preventing diabetes and diabetes complications in the African American and Hispanic communities in eastside and southwest Detroit.

PATH (Personal Action Toward Health) Fact Sheet

National Kidney Foundation    Michigan PATH

The Chronic Disease Self-Management Program (CDSMP) is a workshop given two and a half hours, once a week, for six weeks, in community settings such as senior centers, churches, libraries and hospitals. People with different chronic health problems attend the program together. Two trained leaders facilitate workshops from a highly detailed manual. Subjects covered include: 1) techniques to deal with problems such as frustration, fatigue, pain and isolation, 2) appropriate exercise for maintaining and improving strength, flexibility, and endurance, 3) appropriate use of medications, 4) communicating effectively with family, friends, and health professionals, 5) nutrition, and, 6) making informed treatment decisions.

It is the process in which the CDSMP is taught that makes it effective. Sessions are highly participative, where mutual support and success builds the participants' confidence in their ability to manage their health and maintain active and fulfilling lives.

Does the program replace existing programs and treatments?

The Self-Management Workshop will not conflict with existing programs or treatment. It is designed to enhance regular treatment and disease-specific education such as educational pathways, cardiac rehabilitation, or diabetes instruction. In addition, many people have more than one chronic condition. The program is especially helpful for these people, as it gives them the skills to coordinate all the things needed to manage their health, as well as to help them keep active in their lives.

How was the Program developed?

The Division of Family and Community Medicine in the Department of Medicine at Stanford University received a five-year research grant from the federal Agency for Health Care Research and Policy and the State of California Tobacco-Related Research Project. The purpose of the research was to develop and evaluate, through a randomized controlled trial, a community-based self-management program that assists people with chronic illness. The study was completed in 1996.

The research project had several investigators: Halsted Holman, M.D., Stanford Professor of Medicine; Kate Lorig, Dr. P.H., Stanford Associate Research Professor of Medicine; David Sobel, M.D., Regional Director of Patient Education for the Northern California Kaiser Permanente Medical Care Program; Albert Bandura, Ph.D., Stanford Professor of Psychology; and Byron Brown, Jr., Ph.D., Stanford Professor of Health Research and Policy. The Program was written by Dr. Lorig, Virginia Gonzalez, M.P.H., and Diana Laurent, M.P.H., all of the Stanford Patient Education Research Center. Ms. Gonzalez and Ms. Laurent also served as integral members of the research team.

The process of the CDSMP was based on the experience of the investigators and others with self-efficacy, the confidence one has that he or she can master a new skill or affect one's own health. The content of the workshop was the result of focus groups with people with chronic health problems, in which the participants discussed which content areas were the most important for them.

How was the Program evaluated?

About 1,000 people with heart disease, lung disease, stroke or arthritis participated in a randomized, controlled test of the Program, and were followed for up to three years. We looked for changes in many areas: health status (disability, social/role limitations, pain and physical discomfort, energy/fatigue, shortness of breath, psychological well-being/distress, depression, health distress, self-rated general health), health care utilization (visits to physicians, visits to emergency department, hospital stays, and nights in hospital), s elf-efficacy (confidence to perform self-management behaviors, confidence to manage disease in general, confidence to achieve outcomes), and self-management behaviors (exercise, cognitive symptom management, mental stress management/relaxation, use of community resources, communication with physician, and advance directives).

What were the results?

Subjects, who participated in the program, when compared to those who did not, demonstrated significant improvements in exercise, cognitive symptom management, communication with physicians, self-reported general health, health distress, fatigue, disability, and social/role activities limitations. They also spent fewer days in the hospital, and there was also a trend toward fewer outpatient visits and hospitalizations. These data yield a cost to savings ratio of approximately 1:10. Many of these results persist for as long as three years.


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Gloria Palmisano, Project Manager
REACH Detroit Partnership
c/o CHASS
5635 W. Fort St.
Detroit, MI 48209
Telephone: 313-849-3920
Fax: 313-849-0824
E-Mail: gpalmisano@chasscenter.org
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Racial and Ethnic Approaches to Community Health (REACH) is funded by the National Institutes of Health (NIH).
Community Health and Social Services (CHASS) is the coordinating agency for the project.
Last updated on 5/28/2013
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