Do Program Implementation Factors or Fidelity Affect Chronic Disease Self-Management Education Programs' Outcomes?
OBJECTIVE
To evaluate whether implementation factors or fidelity moderate chronic disease self-management education program outcomes.


METHODS
Meta-analysis of 34 Arthritis Self-Management Program and Chronic Disease Self-Management Program studies.


METHODS
Community.


METHODS
N = 10 792.


METHODS
Twelve implementation factors: program delivery fidelity and setting and leader and participant characteristics. Eighteen program outcomes: self-reported health behaviors, physical health status, psychological health status, and health-care utilization.


METHODS
Meta-analysis using pooled effect sizes.


RESULTS
Modest to moderate statistically significant differences for 4 of 6 implementation factors; these findings were counterintuitive with better outcomes when leaders and participants were unpaid, leaders had less than minimum training, and implementation did not meet fidelity requirements.


CONCLUSIONS
Exploratory study findings suggest that these interventions tolerate some variability in implementation factors. Further work is needed to identify key elements where fidelity is essential for intervention effectiveness.
1 Division of Population Health, Centers for Disease Control and Prevention, Atlanta GA, USA.
Teresa J
TJ
Brady
1 Division of Population Health, Centers for Disease Control and Prevention, Atlanta GA, USA.
Louise B
LB
Murphy
2 ICF International, Rockville, MD, USA.
Benita J
BJ
O'Colmain
2 ICF International, Rockville, MD, USA.
Reeti Desai
RD
Hobson
D001168:Arthritis / Q000628:therapy; D002908:Chronic Disease / Q000628:therapy*; D015438:Health Behavior; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008603:Mental Health; D009042:Motivation; D010353:Patient Education as Topic / Q000379:methods*; D015397:Program Evaluation; D000073278:Self-Management / Q000193:education*
chronic diseases; community program; implementation factors; program outcomes; self-management