189690 Individual and contextual factors that influence multi-morbid older adults' participation in Chronic Disease Self-Management (CDSM) Programs

Monday, October 27, 2008

Melissa N. Dattalo, MPH , School of Medicine, School of Public Health, Johns Hopkins University, Baltimore, MD
Charles E. Boult, MD, MPH, MBA , Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Stephen Wegener, PhD , Department of Physical Medicine and Rehabilitation, The Johns Hopkins University, Baltimore, MD
Erin Rand-Giovannetti , Health Policy and Management, Johns Hopkins University, Baltimore, MD
Lisa Reider, MHS , Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Katherine P. Frey, MPH , Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
PURPOSE OF STUDY: The goal was to quantify individual and contextual influences on participation in chronic disease-self management (CDSM) courses within a population of multi-morbid older adults. DESIGN AND METHODS: Participants in a Guided Care cluster-randomized controlled trial had the option of participating in a CDSM course. Logistic regression with Generalized Estimating Equations was used to build an explanatory model of characteristics associated with CDSM participation. RESULTS: 36.5% of RCT participants attended at least one CDSM session. Individual characteristics independently associated with attendance included having a high school diploma (OR[95% CI] = 1.64[1.29-2.10]), having difficulty with any activity of daily living (OR[95% CI] = 1.57[1.02-2.42]), and having exercised in the past week (OR[95% CI] = 1.83[1.40-2.40]). Contextual factors independently associated with CDSM attendance included receiving health care through an HMO practice (OR[95% CI] = 1.61[1.34-1.94]), rating one's provider highly on “self-care activation” (OR[95% CI] = 0.47[0.33-0.67]), and having been invited to participate by a nurse who values patient interactions highly (OR[95% CI] = 2.18[1.20-3.98]). IMPLICATIONS: Individual and contextual factors influence multi-morbid older persons' participation in CDSM courses. These findings may assist researchers in adjusting for the effects of selection bias and help practitioners to target appropriate subpopulations for CDSM recruitment.

Learning Objectives:
1) Recognize that participants in randomized controlled trials of health promotion programs may not representative of those with the most potential to benefit from the program. 2) Articulate that a program's societal impact is a function of both its efficacy and participation rate. 3) Identify individual and contextual characteristics that influence older adults' decisions to participate in Chronic Disease Self-Management Programs. 4) Apply knowledge of factors that influence participation to improve recruitment methods and ensure health promotion programs are reaching those with the most potential to benefit.

Keywords: Aging, Self-Management

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the student who conducted the data analysis and wrote the manuscript for the research project I am presenting, under the guidance of my faculty adviser. I won the first place award for my poster presentation of this project at the Johns Hopkins School of Public Health Research in Aging Showcase.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.