Chapter 2. Background

Design and Evaluation of Three Administration on Aging (AoA) Programs: Chronic Disease Self-Management Program Evaluation Design—Final Evaluation Design Report (continued)

AoA began funding evidence-based programs in 2003, working with AHRQ, the Centers for Disease Control and Prevention (CDC), the Centers for Medicare and Medicaid (CMS), the Health Resources and Services Administration (HRSA), the Aging Network, and other partners. Recent data from the CDSMP technical assistance provider reported that in the last 12 months, 47 states provided workshops to a little over 30,000 participants (NCOA, personal communication, Jan. 27, 2011). Evidence-Based Disease and Disability Prevention (EBDDP) programs are funded through 24 grants around the country. As part of the funding requirements, the grantee must "implement a Stanford University Chronic Disease Self-Management Program (CDSMP), but also gives each state the option to select another evidence-based program which helps reduce chronic disease in its senior population" (go to http://www.healthyagingprograms.org/content.asp?sectionid=32). Other EBDDP programs cover such topics as physical activity, arthritis, depression, and diabetes self-management. Their cornerstone is that each program is grounded in evidence and uses various education and implementation models to improve the health of older adults (for more information, go to http://www.aoa.gov/AoARoot/AoA_Programs/HPW/Evidence_Based/index.aspx).

A. Description of the Stanford University CDSMP

Several key characteristics of the Stanford CDSMP model intervention make it unique compared to other such EBDDP initiatives. These characteristics include, but are not limited to (1) the use of master and lead trainers, and (2) in-person workshops (versus other modes of training). Stanford CDSMPs are counseled to strictly adhere to specific programs and processes in order to attain and maintain fidelity to the program as originally designed. Some of these fidelity requirements, detailed as "must do's" in the CDSMP Fidelity Toolkit, http://patienteducation.stanford.edu/licensing/Fidelity_ToolKit2010.pdf, 531.5 KB), are described below.

Master Trainers. Master Trainers train the workshop leaders, work in pairs, and serve as workshop leaders themselves. In addition, Master Trainers:

  • Attend 4.5-day Master Training.
  • Facilitate one 4-day Leader training within a year of completing Master Training.
  • Lead a full 4-day Leader Training at least once a year to remain certified.

Lead Trainers. The workshop leaders, also referred to as lay leaders, are the people who facilitate the CDSMP workshops. They work in pairs, and commit to the following requirements:

  • Attend four 6-hour days of training over 2 weeks and complete two practice teachings during training.
  • Commit to facilitating at least one 6-week workshop in the year in which they were trained.
  • Must come from the same communities the CDSMP intends to serve.

In-person workshops:

  • Are offered to group sizes of 10–16 participants.
  • Are offered 2.5 hours a week over 6 weeks.
  • Are conducted by two lay leaders who received training from a Master Trainer.

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B. Other CDSMP Models

There are other self-management models for chronic disease, including such disease-specific Stanford-based models as the Arthritis Self-Management (Self-Help) Program (http://patienteducation.stanford.edu/programs/asmp.html), the Diabetes Self-Management Program (http://patienteducation.stanford.edu/programs/diabeteseng.html), and the Expert Patients Programme (EPP). The EPP is a central component of chronic disease management policy in the United Kingdom (Rogers et al., 2008), and is expected to target over 100,000 people in England and Wales by 2012 (Richardson et al., 2008). The EPP also is evidence‐based and designed to help people with chronic disease self‐manage their conditions, improve their health status, and reduce medical costs. Similar to Stanford's CDSMP, the EPP consists of six weekly workshops conducted in community settings, and is also available as an online tool.

In addition, a number of CDSMP programs based on the Stanford model have made modifications to the program (refer to the literature review in Appendix B). For example, a program concerned with health disparities targeted older African Americans in Philadelphia (Gitlin, Chernett, et al., 2008). The Stanford CDSMP was "translated" for delivery by a senior center, and the evaluation examined whether participants derived benefits similar to those of middle-class Caucasian clients. Nine program modifications were made: name change to Harvest Health; orientation session one week before start of sessions; use of culturally grounded language for key words; reference to "Black church" in instructor's manual replaced with "spirituality"; use of culturally appropriate music during aerobic phase of session; serving of healthy snacks and emphasis on avoiding sweets and salt; introduction of a moment of silence at beginning of each session; additional unit on communicating with a health care provider of a different race; and certificate of completion of program. Other studies reported modifications in delivery mode (i.e., telephone or online) or type of instructor (health professional). It is still unclear whether changes to the traditional Stanford CDSMP influence participant outcomes, but approximately half of the studies reviewed included at least one modification.

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C. AoA's Role in Funding CDSMPs

AoA administers the CDSMP grant program and gives funding to Aging and/or Public Health Departments in the states. While Aging and/or Public Health Departments are the state grantees, there are also host and implementation sites in the state. A host site is the organization that oversees program operations (i.e. AAA) and may also manage recruitment and enrollment of participants. An implementation site (also known as a program delivery site) is where the workshop is conducted (i.e. senior center, YMCA, church). In some locations the host and implementation site are the same place and in others they are not.

AoA has a contract with the National Council on Aging (NCOA) to provide technical assistance to CDSMP grantees (as well as to other EBDDP grantees). Technical assistance includes Web‐based training, on‐site visits, targeted teleconferences, peer‐to‐peer mentoring, strategies and models for developing statewide CDSMP distribution systems, and strategies to sustain programs beyond the grant cycle (http://www.healthyagingprograms.org). NCOA maintains a database on programs, including location, number and characteristics of participants served, and workshops offered.

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Page last reviewed December 2014
Page originally created May 2011
Internet Citation: Chapter 2. Background. Content last reviewed December 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/aoa/aoachronic-2.html