title: Disparities by education level in outcomes of a self-management intervention: the DELTA trial in The Netherlands.
abstract: OBJECTIVE
  The study examined whether education level was associated with benefits derived from a self-management intervention. Because such interventions increase one's sense of control, it was hypothesized that persons with less education, who generally have a diminished sense of control, would derive greater benefit.
  
  
  METHODS
  A randomized trial was conducted with 361 patients aged 60 and older with type 2 diabetes or chronic obstructive pulmonary disease and mild to moderate depression. The intervention provided individualized contacts (two to ten) with nurses who taught participants to take control of their disease.
  
  
  RESULTS
  Positive effects on depression, health-related quality of life, feelings of mastery, and self-efficacy were confined to patients with more education; those with only a primary education did not benefit.
  
  
  CONCLUSIONS
  Only more highly educated patients profited from a cognitive-behavioral approach to self-management. Patients with chronic conditions who have less education may derive greater benefits if environmental adversities or lower cognitive abilities are taken into account.
authors: School for Public Health and Primary Care (CAPHRI), Department of Social Medicine, Maastricht University, P.O. Box 616, Maastricht 6200 MD, The Netherlands. hans.bosma@maastrichtuniversity.nl
authors: Hans
authors: H
authors: Bosma
authors: Femke
authors: F
authors: Lamers
authors: Catharina C M
authors: CC
authors: Jonkers
authors: Jacques T
authors: JT
authors: van Eijk
mesh_terms: D000368:Aged; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000150:complications / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000628:therapy; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000628:therapy; D011788:Quality of Life; D012648:Self Care; D012649:Self Concept; D020377:Self Efficacy; D011795:Surveys and Questionnaires