title: Introducing the chronic disease self-management program in Switzerland and other German-speaking countries: findings of a cross-border adaptation using a multiple-methods approach.
abstract: BACKGROUND
  Stanford's Chronic Disease Self-Management Program (CDSMP) stands out as having a large evidence-base and being broadly disseminated across various countries. To date, neither evidence nor practice exists of its systematic adaptation into a German-speaking context. The objective of this paper is to describe the systematic German adaptation and implementation process of the CDSMP (2010-2014), report the language-specific adaptation of Franco-Canadian CDSMP for the French-speaking part of Switzerland and report findings from the initial evaluation process.
  
  
  METHODS
  Multiple research methods were integrated to explore the perspective of workshop attendees, combining a longitudinal quantitative survey with self-report questionnaires, qualitative focus groups, and interviews. The evaluation process was conducted in for both the German and French adapted versions to gain insights into participants' experiences in the program and to evaluate its impact. Perceived self-efficacy was measured using the German version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6G).
  
  
  RESULTS
  Two hundred seventy eight people attending 35 workshops in Switzerland and Austria participated in the study. The study participants were receptive to the program content, peer-led approach and found principal methods useful, yet the structured approach did not address all their needs or expectations. Both short and long-term impact on self-efficacy were observed following the workshop participation (albeit with a minor decrease at 6-months). Participants reported positive impacts on aspects of coping and self-care, but limited effects on healthcare service utilization.
  
  
  CONCLUSIONS
  Our findings suggest that the process for cross-border adaptation was effective, and that the CDSMP can successfully be implemented in diverse healthcare and community settings. The adapted CDSMP can be considered an asset for supporting self-management in both German-and French-speaking central European countries. It could have meaningful, wide-ranging implications for chronic illness care and primary prevention and potentially tertiary prevention of chronic disease. Further investigations are needed to tailor the program for better access to vulnerable and disadvantaged groups who might benefit the most, in terms of facilitating their health literacy in chronic illness.
authors.affiliation: Research Institute of the Kalaidos University of Applied Science Department of Health, Careum Research, Zurich, Switzerland. joerg.haslbeck@careum.ch.
authors.forename: Jörg
authors.initials: J
authors.lastname: Haslbeck
authors.affiliation: Research Institute of the Kalaidos University of Applied Science Department of Health, Careum Research, Zurich, Switzerland. sylvie.zanoni@careum.ch.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Zanoni
authors.affiliation: Institute of Communication and Health (ICH), Università della Svizzera Italiana, Lugano, Switzerland. uwe.hartung@usi.ch.
authors.forename: Uwe
authors.initials: U
authors.lastname: Hartung
authors.affiliation: Pflegezentrum Bachwiesen, Zurich, Switzerland. margot.klein@zuerich.ch.
authors.forename: Margot
authors.initials: M
authors.lastname: Klein
authors.affiliation: Careum Foundation, Zurich, Switzerland. edith.gabriel@insel.ch.
authors.forename: Edith
authors.initials: E
authors.lastname: Gabriel
authors.affiliation: Inselspital, Bern, Switzerland. manuela.eicher@hefr.ch.
authors.forename: Manuela
authors.initials: M
authors.lastname: Eicher
authors.affiliation: Institute of Communication and Health (ICH), Università della Svizzera Italiana, Lugano, Switzerland. peter.schulz@usi.ch.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Schulz
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D002908:Chronic Disease / Q000628:therapy*; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D004641:Emigration and Immigration; D005060:Europe; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D012648:Self Care / Q000379:methods*; D020377:Self Efficacy; D057566:Self Report; D013557:Switzerland; D055815:Young Adult