title: Randomised controlled trial of a lay-led self-management programme for Bangladeshi patients with chronic disease.
abstract: BACKGROUND
  Reducing the impact of chronic disease in minority ethnic groups is an important public health challenge. Lay-led education may overcome cultural and language barriers that limit the effectiveness of professionally-led programmes. We report the first randomised trial of a lay-led self-management programme - the Chronic Disease Self-Management Programme (CDSMP) (Expert Patient Programme) - in a south Asian group.
  
  
  OBJECTIVE
  To determine the effectiveness of a culturally-adapted lay-led self-management programme for Bangladeshi adults with chronic disease.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  Tower Hamlets, east London.
  
  
  METHODS
  We recruited Bangladeshi adults with diabetes, cardiovascular disease, respiratory disease or arthritis from general practices and randomised them to the CDSMP or waiting-list control. Self-efficacy (primary outcome), self-management behaviour, communication with clinician, depression scores, and healthcare use were assessed by blinded interviewer-administered questionnaires in Sylheti before randomisation and 4 months later.
  
  
  RESULTS
  Of the 1363 people invited, 476 (34%) agreed to take part and 92% (439/476) of participants were followed up. The programme improved self-efficacy (difference: 0.67, 95% confidence interval [CI] = 0.08 to 1.25) and self-management behaviour (0.53; 95% CI = 0.01 to 1.06). In the 51% (121/238) of intervention participants attending three or more of the 6-weekly education sessions the programme led to greater improvements in self-efficacy (1.47; 95% CI = 0.50 to 1.82) and self-management behaviour (1.16; 95% CI = 0.50 to 1.82), and reduced HADS depression scores (0.64; 95% CI = 0.07 to 1.22). Communication and healthcare use were not significantly different between groups. The programme cost pound123 (181) per participant.
  
  
  CONCLUSIONS
  A culturally-adapted CDSMP improves self-efficacy and self-care behaviour in Bangladeshi patients with chronic disease. Effects on health status were marginal. Benefits were limited by moderate uptake and attendance.
authors.affiliation: Interdisciplinary Research Centre in Health, School of Health & Social Sciences, Coventry University. c.j.griffiths@qmul.ac.uk
authors.forename: Chris
authors.initials: C
authors.lastname: Griffiths
authors.forename: Justhna
authors.initials: J
authors.lastname: Motlib
authors.forename: Abdul
authors.initials: A
authors.lastname: Azad
authors.forename: Jean
authors.initials: J
authors.lastname: Ramsay
authors.forename: Sandra
authors.initials: S
authors.lastname: Eldridge
authors.forename: Gene
authors.initials: G
authors.lastname: Feder
authors.forename: Rowshan
authors.initials: R
authors.lastname: Khanam
authors.forename: Rafia
authors.initials: R
authors.lastname: Munni
authors.forename: Myra
authors.initials: M
authors.lastname: Garrett
authors.forename: Andy
authors.initials: A
authors.lastname: Turner
authors.forename: Julia
authors.initials: J
authors.lastname: Barlow
mesh_terms: D000328:Adult; D001459:Bangladesh / Q000208:ethnology; D002908:Chronic Disease / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000191:economics / Q000592:standards*; D017060:Patient Satisfaction; D015397:Program Evaluation; D011788:Quality of Life; D012648:Self Care / Q000379:methods*; D020377:Self Efficacy