Moderators of chronic disease self-management programs: who benefits?

Abstract

Background: The Stanford University Chronic Disease Self-Management Program (CDSMP) has resulted in moderate beneficial outcomes in randomized controlled trials. A study of a modified CDSMP in England suggested that younger participants, those with lower initial self-efficacy and those with greater depression benefited most from the program. Design: Using data from previous CDSMP programs in English and Spanish, we examined whether there were statistically significant interactions between baseline statuses (demographic, disease and health status variables) and randomization (intervention or usual-care control) in estimating 6-month changes in health status (health distress, activity limitation/role function, self-efficacy and self-reported general health). If an interaction was found, post hoc examinations of the relationships between the baseline variables and outcomes determined the directions of the relationships. Results: Six moderating variables were found in the original English-language CDSMP and three in the Spanish program. Each moderator was specific to only one outcome within only one of the two studies. Conclusion: There were no consistent moderating effects across four outcomes and two programs and little evidence to suggest that any groups should be targeted for program recruitment. The CDSMP appears to remain useful to a wide range of people with chronic illness.