title: Activating Patients for Sustained Chronic Disease Self-Management: Thinking Beyond Clinical Outcomes.
abstract: This article describes the impact of an 8-week community program implemented by trained volunteers on the hypertension self-management of 185 patients who were batch randomized to intervention or wait-list control groups. Compared with control group participants, a higher proportion of treatment group participants moved from the cognitive to behavioral stages of motivational readiness for being physically active (P < .001), practicing healthy eating habits (P = .001), handling stress well (P = .001), and living an overall healthy lifestyle (P = .003). They also demonstrated a greater average increase in perceived competence for self-management, F(1.134) = 4.957, P = .028, η2 = .036, and a greater increase in mean hypertension-related knowledge, F(1.160) = 16.571, P < .0005, η(2) = .094. Enduring lifestyle changes necessary for chronic disease self-management require that psychosocial determinants of health behavior are instilled, which is typically beyond standard medical practice. We recommend peer-led, community-based programs as a complement to clinical care and support the increasing health system interest in promoting population health beyond clinical walls.
authors.affiliation: Clemson University, Clemson, SC, USA tcheryl@clemson.edu.
authors.forename: Cheryl J
authors.initials: CJ
authors.lastname: Dye
authors.affiliation: Clemson University, Clemson, SC, USA.
authors.forename: Joel E
authors.initials: JE
authors.lastname: Williams
authors.affiliation: Clemson University, Clemson, SC, USA.
authors.forename: Janet H
authors.initials: JH
authors.lastname: Evatt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003153:Community Health Services / Q000379:methods* / Q000458:organization & administration; D003376:Counseling / Q000379:methods / Q000458:organization & administration*; D019468:Disease Management; D015444:Exercise; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009042:Motivation; D012648:Self Care; D020377:Self Efficacy; D013022:South Carolina
keywords: community health; disease management; lifestyle change; physical activity; rural health