Tomioka et al. (2011)

Replication of the CDSMP in Asian and Pacific Islanders

Self-Efficacy Theory

Community based

Area Agency on Aging employees as leaders

Asian/Pacific Islanders, U.S.

・ Pretest and posttest design

・ 6 week workshop with 6 month follow-up

・ N = 675

・ Mean age: 72

・ Caucasians: 18%

・ Asians: 40.4%

・ Native Hawaiian Pacific Islanders: 42%

・ 86% female

・ 36% with at least a high school education

・ Heterogeneous Disease Sample

・ Demographics, Health outcomes Survey assesses health status, health behaviors, self-efficacy, communication with providers (HCP), and healthcare utilization

・ Validity and Reliability not addressed. Program adapted from CDSMP which has published validity and reliability of outcome measures

Health Status:

・ Significant results for self-rated health in Asian and NHPIs (p = 0.001)

Health distress improvements significant for Caucasians (0.005) and Asians (0.001)


・ Self-efficacy significant in Asians (0.001) and Caucasians (0.012)

・ Communication with HCP all groups statistically significant

Health Behaviors:

・ Exercise and stretching Asian sample statistically (0.001) and (0.001) respectively

Health Care Utilization:

・ Asians statistically significant (0.001)


Higher completion rates than previous studies. AT 6 months Asian participants continued to show benefits.

Limitations: AoA employees as leaders had difficulty finding time to teach. Loss of leaders to job changes and moves. Self-reported data, inconsistent program evaluation between sites.


To API communities, volunteers could limit generalizability


Wu et al. (2011)

Assess effectiveness of self-management program in osteoarthritis patients

Social Learning Theory

Community Residing

Hong Kong

・ Quasi-experimental design

・ 4 weekly classes, post-test with

・ 8 week follow-up

・ Class size 10-15

・ Taiwanese sample, assigned by districts

・ N = 215

・ Control = 125

・ Intervention = 134

・ Mean Age: 67

・ 70% Female

・ 24% College graduate

・ 43% had education levels elementary or below

Diagnosed with Osteoarthritis

・ Demographics at baseline

・ Self-efficacy:

・ Arthritis Self Efficacy (ASE) and ASE other outcomes (previously shown valid and reliable)

・ Change in Pain Beliefs

・ Health Care Utilization

・ Panel of experts determined content validity; test-retest reliability coefficient

・ Baseline showed no statistical difference

・ Intervention Group: Statistically significant of ASE and ASE-OS at follow-up (P < 0.001)

・ Changes in pain beliefs in interventional group statistically significant at each measurement (P < 0.001)

・ Decrease in medical consultations significantly decreased in intervention group (P < 0.003)


Greater increase in self-efficacy suggests that learning self-efficacy behaviors increase self-efficacy, but over time fostering these behaviors results in a larger increase.


Self-report, lack of blindness of participants, (locality assignments used to decreased contamination), low follow-up rate, 8 weeks not long enough to determine long-term effects

Generalizability: Small sample size cannot be generalized; district location, volunteers could limit generalizability


Smeulders et al. (2010)

Evaluate the effectiveness of a nurse lead self-management group in patients with heart failure

Self-Efficacy Theory

Cardiac and Heart Failure Clinics


・ RCT with 12-month follow-up

・ 6 weekly sessions

・ Leaders nurses with two lay role models participating

・ N = 317

・ IG = 186 (76% male)

・ CG = 131 (67% male)

・ Educational level:

・ CG: 69% Secondary educations

・ IG: 64%

・ Diagnosed with heart failure

・ Demographics

・ Self-Care: European Heart Failure Self-Care Behavior Scale

・ QOL: RAND 36 item general health; Kansas City Cardiomyopathy Questionnaire

・ Psychosocial attributes: Perceived Autonomy by Visual Analog Scale

・ Anxiety and Depression: Hospital Anxiety and Depression Scale

・ Stated that instruments were valid and reliable.

・ In comparison of groups:

・ Perceived control and self-efficacy did not show significant change.

・ After intervention IG: Cognitive Symptoms management (P = 0.001), self-care (P = 0.008), QOL (0.005)

・ No statistical different at 6 and 12 months.


Statistically significant results suggest that further, long term studies should be undertaken in the patients with heart failure

Limitations: only study with heart failure patients;

Not able to enroll enough for power to be achieved;

Self-report instruments; low follow-up


Cannot be generalized due to limitations, volunteers could limit generalizability