Home-based, peer-led chronic illness self-management training: findings from a 1-year randomized controlled trial.

PURPOSE: Studies suggest peer-led self-management training improves chronic illness outcomes by enhancing illness management self-efficacy. Limitations of most studies, however, include use of multiple outcome measures without predesignated primary outcomes and lack of randomized follow-up beyond 6 months. We conducted a 1-year randomized controlled trial of Homing in on Health (HIOH), a Chronic Disease Self-Management Program variant, addressing these limitations. METHODS: We randomized outpatients (N = 415) aged 40 years and older and who had 1 or more of 6 common chronic illnesses, plus functional impairment, to HIOH delivered in homes or by telephone for 6 weeks or to usual care. Primary outcomes were the Medical Outcomes Study 36-ltem short-form health survey's physical component (PCS-36) and mental component (MCS-36) summary scores. Secondary outcomes included the EuroQol EQ-5D and visual analog scale (EQ VAS), hospitalizations, and health care expenditures. RESULTS: Compared with usual care, HIOH delivered in the home led to significantly higher illness management self-efficacy at 6 weeks (effect size = 0.27; 95% CI, 0.10-0.43) and at 6 months (0.17; 95% CI, 0.01-0.33), but not at 1 year. In-home HIOH had no significant effects on PCS-36 or MCS-36 scores and led to improvement in only 1 secondary outcome, the EQ VAS (1-year effect size = 0.40; CI, 0.14-0.66). HIOH delivered by telephone had no significant effects on any outcomes. CONCLUSIONS: Despite leading to improvements in self-efficacy comparable to those in other CDSMP studies, in-home HIOH had a limited sustained effect on only 1 secondary health status measure and no effect on utilization. These findings question the cost-effectiveness of peer-led illness self-management training from the health system perspective.

Self-report adherence measures in chronic illness: retest reliability and predictive validity.

BACKGROUND: Patient self-report is a practical method for measuring adherence, but little is known about its optimal use. OBJECTIVES: To examine the retest reliability and predictive validity of 3 different types of self-report adherence measures among patients with common chronic illnesses. RESEARCH DESIGN: Correlation and regression analyses of data from an ongoing randomized controlled trial. SUBJECTS: Patients (N = 415) aged >or=40 years recruited from a primary care network with arthritis, asthma, chronic lung disease, congestive heart failure, depression, and/or diabetes mellitus, plus impairment in >or=1 basic activity and/or a score of >or=4 on the 10-item Center for Epidemiologic Studies Depression Scale. MEASURES: : Self-report adherence (administered variously at baseline, 2, 4, and 6 weeks, and 6 months): number of pills taken/number of pills prescribed (PT/PP), using 1-7 days recall, and global reports of medication adherence and overall adherence tendencies. Six-month functional outcomes: Health Assessment Questionnaire (HAQ) and Short Form-36 (SF-36). RESULTS: Correlation coefficients among contemporaneously administered 1-7 days PT/PP measures were >or=0.78. Correlations among PT/PP measures and global adherence measures, and among PT/PP measures at 2 and 4 weeks, ranged from 0.11 to 0.54. PT/PP measures using >or=3-4 days recall significantly predicted adjusted 6-month HAQ but not SF-36 score. CONCLUSIONS: Self-report PT/PP and general medication adherence measures tap different behavioral constructs. Self-reported PT/PP at a given point in time is not necessarily representative of medication adherence over time. Among chronically ill patients, 3-4 days recall of PT/PP yield adherence estimates, which are practically as reliable and valid as longer intervals and which predict functional outcomes.

Depressive symptoms moderated the effect of chronic illness self-management training on self-efficacy.

BACKGROUND: Identifying moderators of the effects of self-efficacy enhancing interventions could facilitate their refinement and more targeted, cost-effective delivery. Current theories and data concerning the potential moderating effect of depressive symptoms on interventions to enhance patient chronic illness self-management self-efficacy are conflicting. OBJECTIVES: To explore the moderating effect of depressive symptoms on the effect of an intervention to enhance patient self-efficacy for self-managing chronic illness. RESEARCH DESIGN: Regression analyses using baseline and postintervention (6 weeks) data from an ongoing randomized controlled trial. SUBJECTS: Patients (N = 415) aged >or=40 years recruited from a primary care network in Northern California with arthritis, asthma, chronic obstructive pulmonary disease, congestive heart failure, depression, and/or diabetes mellitus, plus impairment in >or=1 basic activity, and/or a score of >or=4 on the 10-item Center for Epidemiologic Studies Depression Scale (CES-D). MEASURES: Stanford self-efficacy scale, self-reported depression, CES-D, and Medical Outcomes Study Short Form health status questionnaire (SF-36) Mental Component Summary score. RESULTS: Regression analyses revealed the intervention was effective primarily in those with self-reported depression (interaction effect F = 8.24, P = 0.0003), highest CES-D score category (F = 5.68, P = 0.0037), and lowest (most depressed) Mental Component Summary-36 tercile (F = 4.36, P = 0.0135). CONCLUSIONS: Individuals with more depressive symptoms seem more likely to experience self-efficacy gains from chronic illness self-management training than individuals with less depressive symptoms. Future self-management training studies should stratify subjects within study groups by depressive symptom level to further explore its potential moderating effect.