Abstract
Objective: The objective of this project was to determine how to improve evaluation of self-management support (SMS) in Canada to generate high-quality evidence to guide policy-makers, implementers, providers and participants.
Methods: This project used a multi-method approach, including a scoping and a focused literature review, an internet scan, interviews with key stakeholders, a review of existing theoretical evaluation frameworks and a consensus meeting with experts.
Results: Four themes were identified through the collection and analysis of data: 1) diverse SMS interventions are identifiable; 2) emerging evaluation activity in Canada is limited to mostly disease-specific, clinic-based programs; 3) there is little evaluation capacity among program implementers in Canada; and 4) there is a gap between the evidence and expectations.
Conclusion: Policy-makers, community organizations and health care teams, regional health authorities and, most importantly, people living with chronic conditions, need better evidence about how to support self-management in their communities. Measuring outcomes must be an explicit part of program implementation and development and requires coordinated support. A common evaluation framework may provide researchers, practitioners and decision- or policy-makers with a systems approach to understanding the possible structural and process factors that can affect self-management outcomes, and could support capacity building in evaluation.
Résumé
Objectif: Déterminer comment améliorer l’évaluation du soutien à l’autogestion des soins (SAS) au Canada afin de produire des preuves de haute qualité pour guider les responsables des politiques, les exécutants, les fournisseurs et les participants au SAS.
Méthode: Nous avons utilisé plusieurs méthodes, dont une étude de champ et une revue de la littérature spécialisée, une exploration d’Internet, des entretiens avec des acteurs privilégiés, un examen des cadres d’évaluation théorique existants et une réunion de concertation avec des spécialistes.
Résultats: Quatre thèmes sont ressortis de la cueillette et de l’analyse des données: 1) diverse interventions en SAS sont identifiables; 2) les activités d’évaluation émergentes au Canada se limitent en gros aux programmes cliniques axés sur certaines maladies; 3) les capacités d’évaluation sont minimes chez les exécutants des programmes au Canada; et 4) il y a un écart entre les preuves et les attentes.
Conclusion: Les responsables des politiques, les organismes communautaires et les équipes de soins de santé, les offices régionaux de la santé et, surtout, les personnes vivant avec des maladies chroniques ont besoin de meilleures preuves sur les moyens de soutenir l’autogestion des soins dans leurs communautés. La mesure des résultats doit faire partie intégrante de l’élaboration et de la mise en œuvre des programmes de SAS, et elle exige un soutien coordonné. Un cadre d’évaluation commun pourrait fournir aux chercheurs, aux praticiens et aux décideurs ou responsables des politiques une approche systémique pour comprendre les facteurs structurels et liés aux processus qui pourraient peser sur les résultats de l’autogestion des soins; un tel cadre pourrait aussi appuyer le renforcement des capacités d’évaluation.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Lorig KR, Holman H. Self-management education: History, definition, outcomes, and mechanisms. Ann Behav Med 2003;26(1):1–7.
Zwar N, Harris M, Griffiths R, Dennis S, Davies GP, Hasan I. A systematic review of chronic disease management. Research Centre for Primary Health Care and Equity, School of Public Health and Community Medicine. Australian Primary Health Care Research Institute, The University of New South Wales School of Public Health and Community Medicine, 2006.
Glasgow RE, Strycker LA, Toobert DJ, Eakin E. A social-ecologic approach to assessing support for disease self-management: The Chronic Illness Resources Survey. J Behav Med 2000;23(6):559–83.
Johnston S, Liddy C, Ives SM, Soto E. Literature Review of Chronic Disease Self-Management. Submitted to the Champlain Local Health Integration Network. April 15, 2008. Available at: http://www.champlainlhin.on.ca/WorkArea/showcontent.aspx?id=2118 (Accessed June 1, 2012).
Borkan J. Immersion/Crystallization. In: Crabtree BF, Miller WL (Eds.), Doing Qualitative Research, 2nd Edition. Thousand Oaks, CA: Sage Publications, 1999.
Wagner EH. Chronic disease management: What will it take to improve care for chronic illness? Eff Clin Pract 1998;1:2–4.
Barr VJ, Robinson S, Marin-Link B, Underhill L, Dotts A, Ravensdale D, Salivaras S. The Expanded Chronic Care Model: An integration of concepts and strategies from population health promotion and the chronic care model. Healthcare Q 2003;7(1):73–82.
Fisher EB, Brownson CA, O’Toole ML, Anwuri VV, Shetty G. Perspectives on self-management from the Diabetes Initiative of the Robert Wood Johnson Foundation. Diabetes Educ 2007;33(S6):216S–224S.
Hogg W, Rowan M, Russell G, Geneau R, Muldoon L. Framework for primary care organizations: The importance of a structural domain. Int J Qual Health Care 2008;20(5):308–13.
McCurdy B, MacKay C, Badley E, Veinot P, Cott C. A Proposed Evaluation Framework for Chronic Disease Prevention and Management Initiatives in Ontario. Working Report for the Arthritis Community Research and Evaluation Unit at the Toronto Western Research Institute, 2008.
Cusack CM, Byrne C, Hook JM, McGowan J, Poon EG, Zafar A. Health Information Technology Evaluation Toolkit: 2009 Update (Prepared for the AHRQ National Resource Center for Health Information Technology under Contract No. 290-04-0016.) AHRQ Publication No. 09-0083-EF. Rockville, MD: Agency for Healthcare Research and Quality, 2009.
Kaiser Permanente Colorado Region Institute for Health Research. RE-AIM, 2009. Available at: http://www.re-aim.org/ (Accessed May 16, 2011).
Stanford School of Medicine. Stanford Patient Education Research Center. 2011. Available at: http://patienteducation.stanford.edu/ (Accessed May 16, 2011).
Paterson BL, van den Hoonaard D, Kealey L, McGibbon C, Mackinnon R, LaChapelle D. Chronic Disease Self-Management Practice in Canada: Patterns, Trends and Programs. Unpublished report submitted to Public Health Agency of Canada, 2009.
Gadoury MA, Schwartzman K, Rouleau M, Maltais F, Julien M, Beaupre A, et al. Self-management reduces both short- and long-term hospitalisation in COPD. Eur Respiratory J 2005;26(5):853–57.
Bourbeau J, Julien M, Maltais F, Rouleau M, Beaupré A, Bégin R, et al. Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: A disease specific self-management intervention. Arch Intern Med 2003;163:585–91.
Bowman A, Epp D. Rural diabetes education: Does it make a difference? Can J Nurs Res 2005;37(1):34–53.
Sherifali D, Greb JL, Amirthavasar G, Hunt D, Haynes RB, Harper W, et al. Effect of computer-generated tailored feedback on glycemic control in people with diabetes in the community: A randomized controlled trial. Diabetes Care 2011;34(8):1794–98.
Centers for Disease Control and Prevention (CDC). Sorting Through the Evidence for the Arthritis Self-Management Program and the Chronic Disease Self-Management Program: Technical Report of ASMP/CDSMP Meta-Analyses. 2011.
Godwin M, Ruhland L, Casson I, MacDonald S, Delva D, Birtwhistle R, et al. Pragmatic controlled clinical trials in primary care: The struggle between external and internal validity. BMC Med Res Methodol 2003;3:28.
Eldridge S. Pragmatic trials in primary health care: What, when and how? Fam Pract 2010;27(6):591–92.
Ware J, Hamel M. Pragmatic trials - Guides to better patient care? N Engl J Med 2011;364(18):1685.
Patton M. Developmental Evaluation: Applying Complexity Concepts to Enhance Innovation and Use. New York, NY: The Guilford Press, 2011.
American Academy of Family Physicians (AAFP). Program: Peers for Progress. Available at: http://peersforprogress.org (Accessed August 1, 2012).
Champlain Local Health Integration Network (LHIN). Program: Living Healthy Champlain. Available at: http://www.livinghealthychamplain.ca (Accessed August 1, 2012).
Author information
Authors and Affiliations
Corresponding author
Additional information
Sources of support: This work was supported by a grant from the Public Health Agency of Canada.
Conflict of Interest: None to declare.
Rights and permissions
About this article
Cite this article
Johnston, S., Liddy, C., Mill, K. et al. Building the Evidence Base for Chronic Disease Self-management Support Interventions Across Canada. Can J Public Health 103, e462–e467 (2012). https://doi.org/10.1007/BF03405639
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03405639