[Results of the Qualitative Evaluation of all-fit--a group education and training program for elderly people with...

Chronic illness in elderly people is often associated with activity limitations, impairment, and mood changes. There is strong evidence that chronic disease self-management programs enhance health behaviour and stabilize or improve health status. A new program in Zurich, called all-fit, is a community-based program consisting of eight educational group sessions and physical training, held over two months. It is designed for elders with chronic illness. The program is led by a specially trained nurse. This study was undertaken to evaluate the program. The qualitative methodology emphasizes the experiences of the participants. Sixteen participants, drawn from the diabetes and arthritis groups, engaged in in-depth interviews before and after their participation in the program. The aim of the study was to assess the outcomes of the program and to identify the ways by which the outcomes occurred. Interview data were analyzed by content analysis. Most participants reported several positive outcomes and described dynamic pathways that led to these outcomes. In analyzing the pathways, the following steps emerged: (1) Motivation to change stems from, for example, activities such as sharing vicarious experiences within the group, or taking on other participants or significant events during the sessions as exemplars. (2) To move on, certain intermediate steps are important, such as cognitive reframing and experimenting with the new behaviour. (3) The resulting change can be attributed to two domains: (a) behaviour change in self-management, such as more time spent exercising or eating healthy; and (b) improvement in psychological well-being, such as having less feelings of depression or new perspectives for future coping. (4) Factors such as remembering highlights and additional group activities contribute to the sustainability of the effects. The results demonstrate that all-fit can be considered as a self-management program that improves health behaviour and physical and psychological well-being. There is a significant dynamic underway which is facilitated by the group setting with participants with similar conditions, social interactions, and concrete, practical learning.