title: National dissemination of chronic disease self-management education programs: an incremental examination of delivery characteristics.
abstract: With a near 20-year developmental history as an evidence-based program, the suite of Chronic Disease Self-Management Education (CDSME) programs were selected in 2010 for grand-scale dissemination in a federally supported initiative to improve the health of older Americans. The primary charge of this national effort was to establish a sustainable program delivery system for empowering American adults with one or more chronic conditions to better manage their health. The current study focused on a series of dissemination and implementation science research questions to: (1) examine the geographic distribution of participation in this initiative across the Unites States; (2) describe workshop characteristics engaged to reach program participants in various settings; and (3) describe personal characteristics of the first 100,000 participants. Each subsequent entering cohort was descriptively examined to indicate whether there was constancy or change in delivery sites and populations reached over time. Findings show a strengthening of the workshop delivery infrastructure in that it took 9.4 months to reach the first 25,000 participants in 853 counties compared to 5.4 months to reach the last 25,000 participants in 1,109 counties. The workshop delivery characteristics and participant characteristics remained relatively consistent across increments of 25,000 participants reached, although general trends were observed for some variables. For example, after reaching the first 25,000 participants, subsequent groups of 25,000 participants were reached more quickly. Additionally, workshops were increasingly delivered in ZIP Codes with higher percentages of families residing below the federal poverty line. As more participants were reached, more participants with chronic conditions were enrolled. This national translational study illustrates the rapid expansion of CDSME programs throughout the United States and capability to reach diverse populations in a variety of settings.
authors.affiliation: Department of Health Promotion and Behavior, College of Public Health, The University of Georgia , Athens, GA , USA.
authors.forename: Matthew Lee
authors.initials: ML
authors.lastname: Smith
authors.affiliation: Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, School of Public Health , College Station, TX , USA.
authors.forename: Marcia G
authors.initials: MG
authors.lastname: Ory
authors.affiliation: Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, School of Public Health , College Station, TX , USA ; Division of Health Systems Management and Policy, School of Public Health, The University of Memphis , Memphis, TN , USA.
authors.forename: SangNam
authors.initials: S
authors.lastname: Ahn
authors.affiliation: National Council on Aging , Washington, DC , USA.
authors.forename: Kristie P
authors.initials: KP
authors.lastname: Kulinski
authors.affiliation: Department of Epidemiology and Biostatistics, Texas A&M Health Science Center, School of Public Health , College Station, TX , USA.
authors.forename: Luohua
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, School of Public Health , College Station, TX , USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Horel
authors.affiliation: Department of Medicine, Stanford Patient Education Research Center, Stanford School of Medicine , Palo Alto, CA , USA.
authors.forename: Kate
authors.initials: K
authors.lastname: Lorig
keywords: chronic disease self-management; evaluation; evidence-based program; older adults; program implementation; program reach; sustainability