Speer, M.S. et al. (2008)

Compare the effects of a statewide diabetic intervention program

None stated

Senior Centers

U.S. (Georgia)

Pre-post design

・ N = 351

・ 55% Black

・ 84% Female

・ Mean Age 77

・ Mean education = 11 years

・ Diabetic sample

・ Diabetes Self-Care Activities (Toobert)

・ Demographics, weight, BMI, HgbA1C

・ Significant decrease in hemoglobin A1C (1%). Increased participation in self-care behaviors.

Self-report instrument, self-report pretest HgbA1C and weight, variability in implementation across state, no control group, convenience sample.

Generalizability:

Cannot be generalized

Goeppinger et al. (2007)

To compare the long-term and short-term effects of the ASHC and the CDSMP

None stated

Community based

U.S.

・ RCT

・ Baseline, 4months and 12 month evaluations

・ Lay leaders

・ N = 416

・ African American = 365

・ Mean Age: 64

・ Mean Education years: 11.7

・ Overall females: 82%

・ Average 4 chronic disease

・ Heterogeneous disease population

・ Demographics

・ Health Related Quality of Life

・ Health care utilization

・ Health Behaviors

・ Arthritis self-efficacy

・ (all instruments previously validated and reliable)

・ ASHC: Increase from baseline in self-efficacy (P = 0.004), general health (P = 0.016), strengthening and stretching and aerobic exercise (P = 0.016)

・ CDSMP: Overall increase in group from baseline in self-efficacy (P = 0.038), disability decrease (P = 0.032), pain decrease (P = 0.05, general health report (0.015)

・ At 4 months continued effectiveness, 1 year did not maintain effectiveness

Interpretation:

Both programs demonstrated benefits in some of the outcomes measured. First study to demonstrate effectiveness in African American population. Difference in long-term effect possibly related to composition of sample. Health low priority for sample.

Limitations: Dropout rate due to time of year. Self-report assessments.

Generalizability: to patients with arthritis, volunteers could limit generalizability

1b

Swerissen et al. (2006)

To determine if the use of the CDSMP in culturally and linguistically diverse cultures will improve health outcomes, satisfaction, and decrease health care utilization

Social Learning Theory

Community setting such as senior centers, churches, and community health centers

Peer leaders

・ RCT

・ 6 weekly sessions, delivered in native language

・ Data collected at baseline and then monthly for 6 months

・ Stratified by language and area; randomized to intervention or wait-list

・ Greek, Vietnamese, Italian, Chinese (control and intervention group in each language)

・ Mean age: 60 - 68

・ Female: 63%

・ Education mean years < 11 in all groups

・ Heterogeneous diseases, and multiple chronic conditions,

・ Demographics

・ Health Status

・ Health Behaviors

・ Self-Efficacy

・ Health Service Utilization

・ (Previous reliability and validity established)

・ Significant increase in health behaviors in the intervention group

・ Health distress (P < 0.001)

・ Activity limitation (P = 0.002)

・ Self-efficacy (P = 0.000)

・ Cognitive symptom (P = 0.001)

・ Pain (P = 0.019)

・ Fatigue (P = 0.01)

・ Depression (P = 0.041)

・ Illness intrusiveness (P = 0.044)

・ Self-rated health (P = 0.025)

・ No difference between two groups in disability scale, or social limitation,

・ No difference in healthcare utilization (already low at baseline)

Interpretations:

Overall positive health outcomes.

Need referral process so that the population with the most need is reached.

Limitations:

The subjects were volunteers and not referred indicating a higher motivation. Wait-list method affected long-term comparison in groups.

Recommend further research in different cultures and languages to determine the effectiveness.

Generalizability: Can only be generalized to the Australian of the language tested in the study, volunteers could limit generalizability

1b

Hass et al. (2005)

Evaluate the effectiveness of chronic disease self-management (CDSMP)in older adults with low back pain

None stated

Community based sites (YW/YMCA’s, churches, senior center)

Australia (Greek, Vietnamese, Chines, and Italian)

・ Prospective, Parallel, RCT

・ Intervention versus 6 month wait list

・ Including phone call every two weeks

・

・ N = 120 (11 dropout)

・ IG = 60

・ Waitlist = 60

・ 84% Female

・ 14.7% African American

・ Education: 95% high school, 24% of those had college

・ Arthritis/Low back pain

・ Demographics

・ Pain

・ Disability

・ Disease Interference

・ Perceived Self-efficacy

・ Attitudes towards Self-health

・ General health rating

・ (Scale validity and reliability addressed)

・ 6 month: no difference between two groups in pain rating, functional disability, days of back pain. No statistical difference between groups in self-efficacy or health attitude

・ Baseline comparison in IG: statistically significant for disability (0.007) days and emotional well-being (0.037)

Interpretations: CDSM had little advantage of routine care in those with low back pain

Limitations: participants refused randomization. Lack of participation by seniors in phone calls, self-report scales, lack of recruitment, cannot follow-up long-term due to design

Generalizability:

Small sample size, unable to generalize to population. volunteers could limit generalizability

1b