title: The Chronic Disease Self-Management Program: the experience of frequent users of health care services and peer leaders.
abstract: BACKGROUND
  Large amount of evidence supports the contribution of the Stanford Chronic Disease Self-Management Program (CDSMP) to a global chronic disease management strategy. However, many studies have suggested further exploring of the factors influencing acceptance and completion of participants in this program.
  
  
  OBJECTIVE
  This study aimed to describe and examine factors associated with acceptance and completion rates of the CDSMP among frequent users of health care services, and to highlight the experience of patients and peer leaders who facilitated the program.
  
  
  METHODS
  A descriptive design with mixed sequential data was used. Acceptance and completion rates were calculated and their relationship with patient characteristics was examined in regression analysis (n = 167). Interviews were conducted among patients who accepted (n = 11) and refused (n = 13) to participate and with the program coordinator. Focus groups were held with the seven peer leaders who facilitated the program. Data were analysed using thematic analysis.
  
  
  RESULTS
  Of the 167 patients invited, 60 (36%) accepted to participate in the program. Group format was the most frequent reason to decline the invitation to participate. Twenty-eight participants (47%) completed the program. Participants who dropped out during the program raised different reasons such as poor health and too much heterogeneity among participants. Factors such as location, schedule, content, group composition and facilitation were considered as important elements contributing to the success of the program.
  
  
  CONCLUSIONS
  The CDSMP could therefore be considered as a self-management support option for this vulnerable clientele, while taking measures to avoid too much heterogeneity among participants to improve completion rates.
authors.affiliation: Département de Médecine de Famille et de Médecine d'urgence, Université de Sherbrooke, Sherbrooke, Québec, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, catherine.hudon@usherbrooke.ca.
authors.forename: Catherine
authors.initials: C
authors.lastname: Hudon
authors.affiliation: Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec and Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada.
authors.forename: Maud-Christine
authors.initials: MC
authors.lastname: Chouinard
authors.affiliation: Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec and.
authors.forename: Fatoumata
authors.initials: F
authors.lastname: Diadiou
authors.affiliation: Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec and.
authors.forename: Danielle
authors.initials: D
authors.lastname: Bouliane
authors.affiliation: Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay, Québec and.
authors.forename: Mireille
authors.initials: M
authors.lastname: Lambert
authors.affiliation: Département des Sciences de la Santé, Université du Québec à Chicoutimi, Saguenay, Québec, Canada.
authors.forename: Émilie
authors.initials: É
authors.lastname: Hudon
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000628:therapy*; D003153:Community Health Services / Q000706:statistics & numerical data; D019468:Disease Management; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D012648:Self Care / Q000379:methods*; D012944:Social Support
keywords: Chronic disease; Stanford.; frequent users; mixed-method; primary health care; program evaluation; self-management; support group