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Do Program Implementation Factors or Fidelity Affect Chronic Disease Self-Management Education Programs' Outcomes?

Teresa J Brady1, Louise B Murphy1, Benita J O'Colmain2

  • 11 Division of Population Health, Centers for Disease Control and Prevention, Atlanta GA, USA.

American Journal of Health Promotion : AJHP
|September 7, 2016
PubMed
Summary

Implementation factors in chronic disease self-management programs show surprising results. Better outcomes occurred with unpaid staff and less than minimum training, suggesting flexibility in program delivery.

Keywords:
chronic diseasescommunity programimplementation factorsprogram outcomesself-management

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Area of Science:

  • Health behavior change
  • Chronic disease management
  • Program implementation science

Background:

  • Chronic disease self-management education programs aim to improve patient outcomes.
  • Understanding the impact of implementation factors on program effectiveness is crucial.

Purpose of the Study:

  • To evaluate if implementation factors or fidelity moderate outcomes of chronic disease self-management education programs.
  • To identify which aspects of program implementation influence effectiveness.

Main Methods:

  • Meta-analysis of 34 studies involving the Arthritis Self-Management Program and Chronic Disease Self-Management Program.
  • Involved 10,792 participants across community settings.
  • Analyzed 12 implementation factors and 18 program outcomes using pooled effect sizes.

Main Results:

  • Modest to moderate statistically significant differences were found for 4 of 6 implementation factors.
  • Counterintuitively, better outcomes were observed when leaders and participants were unpaid.
  • Improved outcomes also noted with less than minimum leader training and when fidelity requirements were not met.

Conclusions:

  • These interventions appear to tolerate some variability in implementation factors.
  • Further research is needed to pinpoint essential elements where fidelity is critical for effectiveness.