Chronic disease is associated with ageing. The population of Singapore is 4.5 millon
in year 2007. It is projected that year 2030, Singapore will have 19% of elderly aged
65 and above. This is an important indicator to initiate strategies in overcoming chronic
health problems in the future. The chronic diseases, such as, diabetes, hypertension
arthritis, heart disease, stroke and lung disease are predisposed to potential
complications in their long term illnesses.
Management of the consequences of the chronic conditions impose a greater burden
on cost of care and impact on the lives of patients and their loved ones. To prevent the
possible long term complications, CDSMP is one of the intervention preventive
approach to help people better manage their chronic condition and lives a healty life.
The program is based on self efficacy theory. The theory suggests that the more self
efficacy people have, the more control in producing own desired outcome.
The CDSMP by Stanford University is comprehensive and well -structured. The program
provides patients with necessary knowledge, skills and confidence to deal with disease
– related problems. It emphasizes on process learning to help patients self manage
their chronic health conditions.
The CDSMP is conducted in a workshop setting whereby people with different chronic
diseases attend together. The programs are designed to help people gain self-confidence
in their ability to control their symptoms and how their health problems affect their lives.
A small group of workshop with the minimum of ten participants, meet once a week
for about 21/2 hours for six consecutive weeks. The same trainers lead the workshop
throughout the six sessions. The workshop focuses on building skills, sharing
experiences and providing mutual support. The trainers aim to facilitate the workshop
in a concisely orderly and interactive manner. To create mutual support and build on
the participants’ confidence in their ability to manage their health condition.
It is the process in which the program is taught that makes the workshop interesting.
The workshop subjects covered include:
Managing symptom emotion and stress through various techniques such as relaxation
breathing techniques, distraction, self-talks exercise visualization
Dealing with negative emotions
Exercise program
Effective use of medication
Healthy eating-tips for eating well
Effective problems solving skills
Focusing on weekly goal settings
Improve communication skills with family relatives and friends
Working in partnership with doctor
Emphasizing interaction through sharing experiences and mutual support
The Self-Management Program would not conflict with existing programs or treatment.
It is designed to enhance regular treatment. The program is aimed to coordinate all the
skills needed to manage their health, as well as to help them keep active in their lives.
The key to the successful self-management with chronic condition is to support of
one and others among peers, practicing tools and techniques learnt from the workshop
in the day – to - day life in living with the chronic condition. Trainers play the roles of
facilitator rather than the teacher by creating a comfortable non -threatening learning
environment for the participants. With mutual support and active participation, the
workshop is fun filled with lots of laughter, learning and sharing. It is a value-added
program to the participants, trainers as well as organization.
The Chronic Disease Self-Management Program (CDSMP)
The Chronic Disease Self-Management Program is a workshop where people with different chronic diseases attend together. The programs are designed to help people gain self-confidence in their ability to control their symptoms and how their health problems affect their lives. A small group of workshop with the minimum of ten participants, meet once a week for about 21/2 hours for six weeks. The workshop session is facilitated by two trained leaders, the two same trainers lead the workshop throughout the six sessions.
The workshop subjects covered include:
Managing symptom emotion and stress through various techniques such as relaxation
breathing techniques, distraction, self talks exercise visualization
Dealing with negative emotions
Exercise program
Effective use of medication
Healthy eating-tips for eating well
Effective problems solving skills
Focusing on goal settings-setting weekly goals
Improve communication skills with family relatives and friends
Working in partnership with doctor
Emphasizing interaction through sharing experiences and mutual support
Does the Program replace existing programs and treatments?
The Self-Management Program would not conflict with existing programs or treatment. It is designed to enhance regular treatment. The program is aimed to coordinate all the things needed to manage their health, as well as to help them keep active in their lives.
The workshop focuses on building skills, sharing experiences and providing mutual support. The trainers aim to facilitate the workshop in a concisely orderly and interactive manner. To create mutual support and build on the participants’ confidence in their ability to manage their health condition. It is the process in which the program is taught that makes the workshop interesting.
Teaching Techniques used in the Chronic Disease Self-Management Workshop
The ideal of self-management in living with chronic problems is to be able to self manage within own capacity, even though it starts with a small step.
The teaching techniques approach used are discussion, brainstorming, demonstration, practice feedback, practice, feedback, problem-solving and action plans. The workshop emphasizes heavily on process learning and not content teaching. The structured teaching tools are based on the Stanford leader manual.
A short oral presentation in which the leaders present facts, principal or explanations on a topic based on the teaching material covered in the CDSMP manual. There are 6 to 7 learning activities to be conducted within the stipulated time frame for the 21/2 hour at each session.
The process of learning is presented with the following teaching techniques:
Explain the purpose of the topic covered for the session
Motivate the group to raise question and problems related to the topics
Cover only those points of the topic that are presented on the charts and elaborate briefly on the topic
Discussions are initiated and facilitated by the leaders. With a verbal exchange of ideas on a topic or problem that occurs during an activity.
Brainstorm on problem, the group is given a question or problem and asked to produce as many ideas as possible and the ideas are written on the white board for brainstorming
Demonstration and practice are used to make the explanation of a skill or technique such as breathing or stretching exercise.
Role-play is used to develop insight on a topic such as communication skills
Participants are given the opportunities to practice a new skill eg setting goal for exercise for the next week and to report how well the participants perform the action plan on the consecutive week
CD sharing on guided imagery
Participants are given some relevant course notes, photocopied from Living a Healthy Life With Chronic Conditions, 3rd Edition
The purpose of the workshop for the six sessions are listed below:
Session One
To introduce the group members to each others
To inform the group about the general principles of self-management
To identify group member’s problems caused by chronic-illness
To differentiate chronic illness from the acute disease
To identify and emphasize the common elements of various chronic health problems
To introduce the causes of symptoms
To introduce self-management techniques
To introduce cognitive symptom management techniques
To practice distract
To introduce action plans as a key self-management tool
Session Two
To introduce problem-solving techniques
To discuss anger, fear and frustration and their management
To introduce the benefits of exercise
To introduce the different types of exercise
Session Three
To introduce the cause of shortness of breath
To assist participants in practicing better breathing techniques
To introduce progressive muscle relaxation
To Introduce the cause of pain and fatigue
To introduce pain and fatigue management techniques
Session Four
To give an overview of good nutrition and a rationale for eating better
To identify some ways to change eating practices
To assist participants in making healthier eating choices
To discuss future plan for health care
To introduce techniques for improving communication
To allow participants to practice problem-solving
To allow participants an opportunity to help others
Session Five
To learn ways of following medication regimens
To learn the general knowledge on medication side effects, medication intolerance and interaction. Participants are advised to consult doctor in-charge of their medication
To introduce positive thinking
To introduce guided imagery
Session Six
To learn skills for communicating with their health care professionals. To participate more actively in their care
To intergrate the skills learned in this workshop into plan for the future
The key to the successful self-management with chronic condition is to support of one and others among peers, practicing tools and techniques learnt from the workshop in the day to day life in living with the chronic condition. Trainers play the roles of facilitator rather than the teacher by creating a comfortable non -threatening learning environment for the participants. With mutual support and active participation, the workshop is fun filled with lots of laughter, learning and sharing. It is a value-added program to the participants, trainers as well as organization.
Reference
http://patienteducation.stanford.edu/trainers/
Survey Questionnaire on Chronic Disease Self Management Programme
Name: ________________________________________ Today's date:_______________
Address: ________________________________________________________________
Telephone: home ( ) - _____________ Date of birth: ________________________
office ( ) - _____________ Sex: Female Male
Background
1. Ethnic origin (check only one):
Chinese
Malay
Indian
Others
2. Please tick the highest year of school completed:
Primary
Secondary
Pre-University
University
3. Are you currently (check only one):
Married separated widowed
Single divorced
4. Please indicate below which chronic condition(s) you have:
Diabetes Asthma Emphysema or COPD
Other lung disease Type of lung disease:____________________________
Heart disease Type of heart disease:____________________________
Arthritis or other rheumatic disease Specify type:_________________________
Cancer Type of cancer:____________________________________
Other chronic condition Specify:
General Health
1. In general, would you say your health is:
(Circle one)
Excellent .............................. 1
Very good.............................. 2
Good...................................... 3
Fair ........................................4
Poor....................................... 5
Symptoms
How much time during the past 2 weeks...
None A little Some A good Most All
of the of the of the bit of of the of the
time time time the time time time
1. Were you discouraged by your
health problems?..................................... 0 1 2 3 4 5
2. Were you fearful about your
future health? .......................................... 0 1 2 3 4 5
3. Was your health a worry in your life? .. 0 1 2 3 4 5
4. Were you frustrated by your
health problems?..................................... 0 1 2 3 4 5
1. We are interested in learning whether or not you are affected by fatigue. Please circle the number below that describes your fatigue in the past 2 weeks:
0 1 2 3 4 5 6 7 8 9 10
No Severe
fatigue fatigue
2. We are interested in learning whether or not you are affected by shortness of breath. Please circle the number below that describes your shortness of breath in the past 2 weeks:
0 1 2 3 4 5 6 7 8 9 10
No Severe
shortness shortness
of breath of breath
3. We are interested in learning whether or not you are affected by pain. Please circle the number below that describes your pain in the past 2 weeks.
0 1 2 3 4 5 6 7 8 9 10
No Severe
pain pain
Physical Activities
During the past week, even if it was not a typical week for you, how much total time (for the entire week) did you spend on each of the following? (Please circle one number for each question.)
less than 30-60 1-3 hrs/ more than
none 30 min/wk min/wk wk 3 hrs/wk
1. Stretching or strengthening exercises
(range of motion, using weights, etc.) ....... 0 1 2 3 4
2. Walk for exercise...................................0 1 2 3 4
3. Swimming or aquatic exercise............... 0 1 2 3 4
4. Bicycling (including stationary
exercise bikes).........................................0 1 2 3 4
5. Other aerobic exercise equipment
(Stairmaster, rowing, skiing
machine, etc.) ..........................................0 1 2 3 4
6. Other aerobic exercise
Specify_________________________... 0 1 2 3 4
Confidence About Doing Things
For each of the following questions, please circle the number that corresponds with your confidence that you can do the tasks regularly at the present time.
How confident are you that you can...
1. Keep the fatigue caused by your disease from interfering with the things you want to do?
not at all | | | | | | | | | | totally
confident 1 2 3 4 5 6 7 8 9 10 confident
2. Keep the physical discomfort or pain of your disease from inter- fering with the things you want to do?
not at all | | | | | | | | | | totally
confident 1 2 3 4 5 6 7 8 9 10 confident
3. Keep the emotional distress caused by your disease from interfering with the things you want to do?
not at all | | | | | | | | | | totally
confident 1 2 3 4 5 6 7 8 9 10 confident
4. Keep any other symptoms or health problems you have from interfering with the things you want to do?
not at all | | | | | | | | | | totally
confident 1 2 3 4 5 6 7 8 9 10 confident
5. Do the different tasks and activities needed to manage your health condition so as to reduce your need to see a doctor?
not at all | | | | | | | | | | totally
confident 1 2 3 4 5 6 7 8 9 10 confident
6. Do things other than just taking medication to reduce how much your illness affects your everyday life?
not at all | | | | | | | | | | totally
confident 1 2 3 4 5 6 7 8 9 10 confident
Daily Activities
During the past 2 weeks, how much... (Circle one)
Not Quite Almost
at all Slightly Moderately a bit totally
1. Has your health interfered with
your normal social activities with family,
friends, neighbors or groups?...........................0 1 2 3 4
2. Has your health interfered with
your hobbies or recreational activities? ...........0 1 2 3 4
3. Has your health interfered
with your household chores? ...........................0 1 2 3 4
4. Has your health interfered with
your errands and shopping? .............................0 1 2 3 4
Medical Care
1. When you visit your doctor, how often do you do the following (please circle one number for each question):
Almost Some- Fairly Very
Never never times often often Always
a. Prepare a list of questions
for your doctor ........................................ 0 1 2 3 4 5
b. Ask questions about the things you
want to know and things you don’t
understand about your treatment............. 0 1 2 3 4 5
c. Discuss any personal problems that
may be related to your illness ................. 0 1 2 3 4 5
2. In the past 6 months, how many times did you visit a physician?
Do not include visits while in the hospital or the hospital emergency department...__________ visits
3. In the past 6 months, how many times did you go to
a hospital emergency department?............................................................................_________times
4. In the past 6 months, how many TIMES were you hospitalized
for one night or longer? .............................................................................................__________ times
a. How many total NIGHTS did you spend in the hospital in the
past 6 months?....................................................................__________ nights
b. Were any of these hospitalizations at a skilled nursing facility,
convalescent hospital, or other minimum care facility? (circle) ............. Yes No
Thank you for your help
Questionnaire on chronic disease August 2007 adopted from
Stanford Patient Education Research Center Stanford University
Chronic Disease Self Management Program (CDSMP) 9 to 13 July 2007, California, USA, Stanford University
Aim: To acquire the skills and knowledge in CDSMP and able to conduct the workshop for patients living with chronic condition.
Background: Over the past 24 years, the Stanford Patient Education Research Center has developed, tested, and evaluated self-management programs for people with chronic health problems. The first program was the Arthritis Self-Management Course (also known as the Arthritis Self-Help Workshop), which became the prototype for all of their self-management programs.
The CDSMP are designed to help people gain self-confidence in their ability to control their symptoms and how their health problems affect their lives. The program is based on self-efficacy theory and incorporates skills mastery, reinterpretation of symptoms, modeling and social persuasion through group support and guidance for individual self management efforts.
Program Details:
Objectives
At the end of CDSMP, participants will be able to:
1. Explain the concept of self-efficacy in chronic disease self-management
2. Discuss the teaching strategies to enhance self-efficacy
3. Apply the teaching strategies when conducting the training
4. Conduct the chronic disease self management (CDSM) workshop with another trained co-leader.
Course Content
Day 1
Project and training overview
Differences between acute and chronic illness
Using your mind to manage symptom and distraction
Action planning
Dealing with difficult emotions
Physical activities and exercise
Review of training techniques
Practice teaching assignments, questions , training issues
Day 2
Feedback, problem-solving, making an action plan
Better breathing
Muscle relaxation
Pain and fatigue management
Endurance activities
Practice teaching
New practice teaching assignment
Day 3
Future plan for healthcare
Health-eating
Communication skills
Problem-solving
Medication usage
Making informed treatment decisions
Depression management
Positive thinking
Guided Imagery
Day 4
Working with your healthcare professional
Looking back and planning for the future
Handling situation in groups
Practice teaching
Practice teaching review
What are you afraid might happen
Day 5
Feedback/problem-solving
Program implementation exercise
Looking back and planning for the future
Ask the experts ( panel of peer leaders)
Wrap up, certificates
Key Learning Points
Patient
Patients are empowered with the knowledge to self-manage their own chronic health conditions
Take responsibilities of their own health
Peer modeling
Patients with chronic disease are trained to be lay leaders and also the resource persons
Staff
Well structured program based on extensive research
Good facilitating skills
Teaching strategies simple and easy to follow
Emphasize on process learning and not on disease perspective
Learning process is interactive
Cross-cultural learning as participants are from different nationalities
Leader modeling
Partnership care between healthcare professional and patient
Institution
Promote healthy living and prevent potential complications
Reduce repeated hospital admissions
Teaching manual is a good source for patient education
Reach out to the community
Limitations
Strict adherence to the Master’s training manual
The manual is only available in English and not other local languages.
The examples from the trainers manual need to be modified to our local context.
Cannot conduct workshop until license is obtained by the institution.
License was obtained wef 1.1.08 and first workshop was started on 5.1.08
Recommendations
This course requires the participants to conduct two CDSM workshops in order to be certified as master trainers.
Currently trainers manuals are available in English and Chinese only, may need to consider making it available in Malay and Tamil in the near future.
To invite trainers from Stanford University to conduct on-site training will be more cost effective.
Conclusion
Patients with increased chronic conditions impose a greater burden to the cost of care. The need for self management living with chronic disease is increasingly recognized globally based on the fact of ageing population.
The CDSMP by Stanford is comprehensive and well-structured. The program provides patients with necessary knowledge, skills and confidence to deal with disease – related problems. It emphasizes on process learning to help patients self manage their chronic health conditions. We believe that this program will benefit the patients as the program is aimed to improve the physical, emotional health of patients while reducing costs to the disease management.
