Lorig et al. (2005)

Compare disease specific self-management (ASMP) versus generic self-management (CDSMP)

Self-efficacy theory

Community centers



・ Randomized to either disease specific (ASMP) or Generic (CDSMP)

・ Data Collected at baseline, 4 months, and 12 months

・ ASMP = 239

・ CDSMP = 116

・ Mean age = 65

・ Years of Education = 16

・ Female: ASMP 81%

・ CDSMP: 78%

・ Diagnosed with Arthritis

・ Demographics

・ Health Distress

・ -Self-reported Global Health

・ Activity Limitation

・ -Disability

・ Fatigue

・ Pain

・ -Aerobic Exercise

・ Stretching and Strengthening

・ Self-efficacy

・ Physician Visits

・ Hospitalizations

・ -Validity and Reliability Addressed

・ Improvement in individual groups compared to baseline

・ 4-month: ASMP demonstrated greater improvement in health distress, activity limitation, and fatigue

・ 1 year: ASMP had significant improvements in health distress, activity limitation, disability, fatigue, pain, practice mental stress management, stretching and strengthening, and self-efficacy


ASMP has advantages compared to CDSMP, lessening slightly at 1 year

Limitations: CDSMP enrollment half of ASMP,


Recommendations: As chronic diseases are different need to study other disease specific groups to see if positive effects are achieved versus the CDSMP

Generalizability: Not addressed, adequate power for sample size. volunteers could limit generalizability


Farrell et al. (2004)

To evaluate the effectiveness and acceptability of the CDSMP in the underserved, poor, rural, predominantly African American population (pilot)

Self-Efficacy Theory


Rural, underserved, socioeconomically declined



・ Quasi-experimental, pre-post design

・ 6-week intervention

・ Lay leaders from community

・ N = 48

・ 79% Caucasian

・ 81% women

・ Mean Age: 60

・ Education Mean: 12 years

・ Heterogeneous chronic diseases

・ Demographics

・ Self-efficacy: Self-Efficacy Cantril Ladder (face and content validity)

・ CDSMP validated and reliable testing done previously for instruments used for

・ Health behaviors

・ Symptom management

・ Communication Provider

・ Improvement in all measurements noted, but only self-efficacy (P = 0.01) cognitive symptom management (P = 0.10 were significant immediately after intervention


All findings consistent with previous studies of similar populations except for exercise being slightly increased which is not normally seen. Possibly due to location or timing of study.

Limitations: heterogeneous patient mix, lack of comparison group with usual care, short-term follow-up, pre-post design, and convenience sampling.

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


Lori, K.R. et al. (2001)

To assess the 1 year and 2-year effect of the CDSMP on health status, self?efficacy and healthcare utilization

Self-Efficacy Theory



・ Longitudinal follow-up to RCT-2 year

・ Lay leaders, observational education

・ Randomized sample with wait list rotation into program.

・ N = 683

・ Mean age: 65.3

・ 64% female

・ 90% Caucasian

・ Education: 15 years

・ Heterogeneous Disease Sample

・ Demographics

・ Health Status

・ Healthcare Utilization

・ Perceived Self-Efficacy

・ Discussion of validation of newly validated tools provided.

・ At 1 and 2 year, decreased healthcare utilization (0.006), health distress (0.0001) and increased self-efficacy (0.0001)

・ All other measures were not significant


Findings support the use of the 7 week program to decrease hospital visits and health distress. Participants with 2 chronic diseases did not show deterioration during the study period.

Limitations: to interpreting findings: Dropout rate, lack of control group due to wait list method design so true comparison not a possibility


Based on these results and previous studies recommend tertiary implementation of CDSMP/volunteers could limit generalizability


Lorig et al. (1999)

Explore the effectiveness of a chronic disease self-management program with a heterogeneous group of chronic disease patients

Self-Efficacy Theory

Community based sites


・ 6 month RCT, wait-list control subjects,

・ Intervention including role-modeling, feedback, and goal setting, 7 weekly sessions, lay leaders, small classes

・ Randomized sample

・ N = 952

・ Mean Age Control: 65

・ Mean Age Intervention: 65.6

・ 64% and 65% female respectively

・ 91% Caucasian

・ Average 2.2 chronic disease

・ Heterogeneous Disease Sample

・ Demographics

・ Health Status: Self-rated-Health Scale and modified-Health Assessment Questionnaire Disability Scale; Medical Outcomes Survey (MOS) Pain Scale, MOS distress scale, MOS fatigue and energy scale,

・ Health Behaviors: scales developed for this study

・ Healthcare utilization: scales developed for this study

・ Validity and Reliability discussed

・ At 6 months, intervention group had significant (p < 0.05) increased exercise (P = 0.01), improvement in cognitive symptoms management (P = 0.01), communication with providers (P = 0.01), self-rated health, fatigue, disability, and social limitations. (P = 0.02)

・ Decrease in provider visits and days in hospital.

・ Other indicators were not significant


Based on the findings, suggests that the individual can be successfully used with a heterogeneous groups of diseases and not disease specific.

Limitations: Not all patients had same symptoms and need same changes in behavior. Difficult to evaluate homogeneously due to comorbidities

Need replication to determine effectiveness of proposed program.

Generalizability: generalizability limited due to participants volunteering for study affecting motivation