title: Implementation of Patient-Centered Education for Chronic-Disease Management in Uganda: An Effectiveness Study.
abstract: BACKGROUND
  The majority of non-communicable disease related deaths occur in low- and middle-income countries. Patient-centered care is an essential component of chronic disease management in high income settings.
  
  
  OBJECTIVE
  To examine feasibility of implementation of a validated patient-centered education tool among patients with heart failure in Uganda.
  
  
  METHODS
  Mixed-methods, prospective cohort.
  
  
  METHODS
  A private and public cardiology clinic in Mulago National Referral and Teaching Hospital, Kampala, Uganda.
  
  
  METHODS
  Adults with a primary diagnosis of heart failure.
  
  
  METHODS
  PocketDoktor Educational Booklets with patient-centered health education.
  
  
  METHODS
  The primary outcomes were the change in Patient Activation Measure (PAM-13), as well as the acceptability of the PocketDoktor intervention, and feasibility of implementing patient-centered education in outpatient clinical settings. Secondary outcomes included the change in satisfaction with overall clinical care and doctor-patient communication.
  
  
  RESULTS
  A total of 105 participants were enrolled at two different clinics: the Mulago Outpatient Department (public) and the Uganda Heart Institute (private). 93 participants completed follow up at 3 months and were included in analysis. The primary analysis showed improved patient activation measure scores regarding disease-specific knowledge, treatment options and prevention of exacerbations among both groups (mean change 0.94 [SD = 1.01], 1.02 [SD = 1.15], and 0.92 [SD = 0.89] among private paying patients and 1.98 [SD = 0.98], 1.93 [SD = 1.02], and 1.45 [SD = 1.02] among public paying patients, p<0.001 for all values) after exposure to the intervention; this effect was significantly larger among indigent patients. Participants reported that materials were easy to read, that they had improved knowledge of disease, and stated improved communication with physicians.
  
  
  CONCLUSIONS
  Patient-centered medical education can improve confidence in self-management as well as satisfaction with doctor-patient communication and overall care in Uganda. Our results show that printed booklets are locally appropriate, highly acceptable and feasible to implement in an LMIC outpatient setting across socioeconomic groups.
authors.affiliation: Division of Pulmonary and Critical Care, Johns Hopkins University, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.|Department of Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America.
authors.forename: Trishul
authors.identifier: http://orcid.org/0000-0001-9914-1839
authors.initials: T
authors.lastname: Siddharthan
authors.affiliation: Department of Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America.
authors.forename: Tracy
authors.initials: T
authors.lastname: Rabin
authors.affiliation: Global Health Leadership Institute, Yale University, New Haven, Connecticut, United States of America.
authors.forename: Maureen E
authors.initials: ME
authors.lastname: Canavan
authors.affiliation: College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Faith
authors.initials: F
authors.lastname: Nassali
authors.affiliation: Department of Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Phillip
authors.initials: P
authors.lastname: Kirchhoff
authors.affiliation: College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Robert
authors.initials: R
authors.lastname: Kalyesubula
authors.affiliation: Department of Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America.|Department of Nephrology, Mt. Sinai Hospital, Mount Sinai School of Medicine, New York, New York, United States of America.
authors.forename: Steven
authors.initials: S
authors.lastname: Coca
authors.affiliation: Department of Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America.
authors.forename: Asghar
authors.initials: A
authors.lastname: Rastegar
authors.affiliation: Department of Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America.|Department of Nephrology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Knauf
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D014454:Uganda