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Spanish tobacco-related disease self-management: evaluation

Institution: Stanford University
Investigator(s): Kate Lorig, Ph.D.
Award Cycle: 1997 (Cycle 6) Grant #: 6RT-0107 Award: $693,751
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: Research Project Awards

Initial Award Abstract
As our population ages, chronic disease has become the number one cause of death and disability. Today, approximately 70 cents of each health care dollar is spent on chronic conditions such as tobacco-related heart disease and lung diseases. This problem is especially acute in the Hispanic population, which has more chronic disease related disability and less access to care than the general population.

Because chronic diseases usually last a lifetime, they must be managed not only by the health care system but also by the person with the disease. The individual is responsible for day to day management of all aspects of the condition, from taking medication and exercising, to continuing to work, to manage negative emotions such as depression and frustration. To be a successful chronic disease self-manager takes practice and skill.

The purpose of this project is to develop and evaluate a community based chronic disease self-management program for Spanish speaking patients with tobacco-related heart disease or lung disease. Patients in 4 San Francisco Bay area counties will be randomly assigned to take a 7 week Chronic Disease Self Management Program right away at a community site near their home or to wait for 4 months before taking the program. All patients taking the program will be followed for 1 year. Questionnaires by mail and telephone at the beginning of the program and 4 and 12 months later will ask about health behaviors such as exercise and smoking, and will also measure how much chronic disease interferes with what patients want and need to do. Finally, we will measure how people use doctors, emergency rooms and hospitals.

In past studies with English speakers, we have demonstrated that patients taking a Management Program increased their healthful behaviors, had improved health status, and had fewer days in the hospital, compared to those who did not take the program. The savings were approximately $10 for every $1.00 spent on the program. Similar findings from this proposed study for Spanish-speakers would result in better quality of life for the participants and substantial cost savings for the health care system. Once shown to be effective, the program can be used by state and local health departments, community agencies, and those who deliver health care, such as community clinics and HMOs.

Final Report
There are three crucial components to the care of tobacco-related chronic diseases. These are traditional medical care, surgical care and patient self-management education. The latter is a potentially critical ingredient of appropriate health services, especially for the Latino population, who not only carries the heavy burden of chronic disease comorbidities, but also encounters limited access to health care and health education. If successful, the Spanish Chronic Disease Self-Management Program (SCDSMP) will provide a low cost and cost effective means of providing services to Spanish-speakers. The aims of the original study were to 1) develop, implement and evaluate, in a 4 month randomized trial, a 6 week experimental Spanish language self-management education program for people with coronary artery disease and chronic lung disease; and 2) determine if the program is differentially effective across disease subgroups. Since the initiation of this project, we have received supplemental funding from the National Institute for Nursing Research, which has allowed us to expand the original 3-year study to 5 years, and to expand the study’s aims. The study now includes a third target disease, diabetes. In addition, there is a third aim to evaluate the program not only in a 4 month randomized trial but also in a 1-year longitudinal study.

In the past year we have extended the aims of the original study to determine if the people with diabetes have better outcomes if they attend the SCDSMP or a disease specific Spanish Diabetes Self-Management Program. We will examine outcomes in a 4 month randomized trial.