title: Comparing effectiveness of generic and disease-specific self-management interventions for people with diabetes in a practice context.
abstract: BACKGROUND
  The effectiveness of self-management interventions has been demonstrated. However, the benefits of generic vs. disease-specific programs are unclear, and their efficacy within a practice setting has yet to be fully explored.
  
  
  OBJECTIVE
  To compare the outcomes of the diabetes-specific self-management program (Diabetes) and the generic chronic disease Self-management Program (Chronic Condition) and to explore whether program characteristics, evaluated using the Quality Self-Management Assessment Framework (Q-SAF), provide insight into the results of the outcome evaluation.
  
  
  METHODS
  A pragmatic pretest, post-test design with 12-week follow up was used to compare the 2 self-management interventions. Outcomes were quality of life, self-efficacy, loneliness, self-management skills, depression, and health behaviours. People with diabetes self-selected attendance at the Diabetes or Chronic Condition program offered as part of routine practice.
  
  
  RESULTS
  Participants with diabetes in the 2 programs (Diabetes=200; Chronic Condition=90) differed significantly in almost all demographic and clinical characteristics. Both programs yielded positive outcomes. Controlling for baseline and demographic characteristics, random effects modelling showed an interaction between time and program for 1 outcome: self-efficacy (p=0.029). Participants in the Chronic Condition group experienced greater improvements over time than did those in the Diabetes group. The Q-SAF analysis showed differences in program content, delivery and workforce capacity.
  
  
  CONCLUSIONS
  People with diabetes benefited from both programs, but participation in the generic program resulted in greater improvements in self-efficacy for participants who had self-selected that program. Both programs in routine care led to health-related improvements. The Q-SAF can be used to assess the quality of programs.
authors.affiliation: School of Occupational Therapy and Social Work, Curtin University, Perth, Australia; School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada. Electronic address: setareh.ghahari@queensu.ca.
authors.forename: Setareh
authors.initials: S
authors.lastname: Ghahari
authors.affiliation: School of Occupational Therapy and Social Work, Curtin University, Perth, Australia; School of Occupational Therapy and School of Nursing, Dalhousie University, Halifax, Canada.
authors.forename: Tanya
authors.initials: T
authors.lastname: Packer
authors.affiliation: School of Nursing, Curtin University, Perth, Australia.
authors.forename: Duncan
authors.initials: D
authors.lastname: Boldy
authors.affiliation: Department of Health, Western Australia, Perth, Australia.
authors.forename: Lauren
authors.initials: L
authors.lastname: Melling
authors.affiliation: School of Occupational Therapy and Social Work, Curtin University, Perth, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Parsons
mesh_terms: D002908:Chronic Disease / Q000523:psychology / Q000628:therapy; D003376:Counseling; D003920:Diabetes Mellitus / Q000523:psychology* / Q000628:therapy; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D012648:Self Care / Q000379:methods*; D016896:Treatment Outcome
keywords: affections de longue durée; chronic conditions; chronic illness; diabetes; diabète; maladie de longue durée; prise en charge autonome; self-management