title: Increasing access to chronic disease self-management programs in rural and remote communities using telehealth.
abstract: OBJECTIVE
  This study examined whether a telehealth chronic disease self-management program (CDSMP) would lead to improvements in self-efficacy, health behaviors, and health status for chronically ill adults living in Northern Ontario, Canada. Two telehealth models were used: (1) single site, groups formed by participants at one telehealth site; and (2) multi-site, participants linked from multiple sites to form one telehealth group, as a strategy to increase access to the intervention for individuals living in rural and remote communities.
  
  
  METHODS
  Two hundred thirteen participants diagnosed with heart disease, stroke, lung disease, or arthritis attended the CDSMP at a preexisting Ontario Telemedicine Network studio from September 2007 to June 2008. The program includes six weekly, peer-facilitated sessions designed to help participants develop important self-management skills to improve their health and quality of life. Baseline and 4-month follow-up surveys were administered to assess self-efficacy beliefs, health behaviors, and health status information. Results were compared between single- and multi-site delivery models.
  
  
  RESULTS
  Statistically significant improvements from baseline to 4-month follow-up were found for self-efficacy (6.6±1.8 to 7.0±1.8; p<0.001), exercise behavior, cognitive symptom management, communication with physicians, role function, psychological well-being, energy, health distress, and self-rated health. There were no statistically significant differences in outcomes between single- and multi-site groups.
  
  
  CONCLUSIONS
  Improvements in self-efficacy, health status, and health behaviors were equally effective in single- and multi-site groups. Access to self-management programs could be greatly increased with telehealth using single- and multi-site groups in rural and remote communities.
authors.affiliation: Women's College Research Institute, Department of Physical Therapy, University of Toronto, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario M5G 1V7, Canada. susan.jaglal@utoronto.ca
authors.forename: Susan B
authors.initials: SB
authors.lastname: Jaglal
authors.forename: Vinita A
authors.initials: VA
authors.lastname: Haroun
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Salbach
authors.forename: Gillian
authors.initials: G
authors.lastname: Hawker
authors.forename: Jennifer
authors.initials: J
authors.lastname: Voth
authors.forename: Wendy
authors.initials: W
authors.lastname: Lou
authors.forename: Pia
authors.initials: P
authors.lastname: Kontos
authors.forename: James E
authors.initials: JE
authors.lastname: Cameron
authors.forename: Rhonda
authors.initials: R
authors.lastname: Cockerill
authors.forename: Tarik
authors.initials: T
authors.lastname: Bereket
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000628:therapy*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D012424:Rural Population; D012648:Self Care; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D017216:Telemedicine