Dear Kate,

It stands to reason that some of the same personal factors (e.g., optimism) that lead a person to begin a program (whether that be a group program or a self-directed or self-paced program) will also be related to whether and for long they stay engaged in a program, but it's been my experience that there's very little overlap between the predictors of program initiation and those of program engagement. There's also little overlap between personal predictors of program initiation and program outcomes. Furthermore, these predictors are most likely moderated by specific program characteristics (e.g, program focus; program demands, etc.) and that it's difficult to generalize across programs.

I'm pretty sure you're aware of Ralf Schwartzer's Health Action Process Approach (HAPA), since Ralf spent time out in Stanford with Al Bandura many years ago, but, if not, check it out for a theoretical model that might give you some insights.

Regards,

Ken

Dear Kate,

a few years ago, I wrote an article about this. You can find it here:

http://link.springer.com/article/10.1007%2FBF03324777

Kind regards,

Henrike

Dear Kate,

Last month we published a paper in PLOSone on determinants of activation for self-management in 4 chronic diseases: COPD, DM-II, HF & Renal disease. The PAM-13 was used as a dependent variable and a large number of patient, disease and context variables as covariates. Although this does not specifically focused at engagement in programs/interventions this might provide some increased understanding on the variance in engagement for SM in general. 

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0126400 

Kind regards

Jaap 

Thanks Jaap--nice paper

Hi Kate !

Your are the true pioneer for initiating and studying self management programs and in particular, with arthritis , training the trainer or facilitator.

Your eloquent, thoughtful questions seem intuitively obvious, but would be very challenging to sort out , via a study with multiple confounding variables (both patient participants and the facilitators) as point out by Ken.  Certainly correlations could be made, but it would tough to ascertain causation or directionality, but merely association.

I had led the ACR Study Group Session at the National Meeting for 3 years after Ted and Fred past the torch to myself and Arthur Stone and Joan Broderick.  As you are aware they are experts in the "science of self report" measures.  We had Halstead Holman and yourself discuss group sessions with the doctor to be held as a group visit.  Certainly the telephone support you created can be useful.

In looking back over the last 35 years of practice, subject to severe recall bias, I am more inclined to think that the answer to your question is multifactorial and yet one might be able to collect data on engagement - list of reason(s) why folks stay engaged  and put them into a Wilcoxan Summary Rank order vs those who did not remain engaged (though capturing that data would be more challenging).  I suspect that the rank order of reasons for and against would likely differ.

The question as to whether the differences related more to patient demographics such as age, educational level, social support, transportation and access,  duration of illness, disease severity, beliefs, attitudes , perceptions,  expectations, self efficacy or to the facilitators personality, skills to engage, flexibility, etc  , I would suspect the latter may be more important than content.

Perhaps with advancing technology and cheaper social media resources, the evolution of the presentation of the self management tools and participation with feedback to questions to check understanding, attitudes , etc will help keep people engaged while also giving them the range of feedback (obviously HIPAA deidentified) that other patients initiating and completing the modules had provided.

Both introverts and extroverts could participate and one person (like the famous KL) could be filmed for the modules so consistency of presentation as well as content is guaranteed.   Perhaps Walter Cronkite (may he RIP) would have volunteered to read the teleprompter, but someone with your skills sets in asking questions and facilitating responses would be essential to the success of the program.

Sorry I can't point you to any specific literature I have come across that directly answers your question.  The Henrike , Japp, and Ken papers are of interest and excellent as one ponders your thoughtful question.

hi,in my work on 75 participant with hypertensive ,i couldnt predict who and why some participated actively.but the patients with higher perceived severity of risk and  higher Community mood and literacy were actively.also some enjoyed  to pay attention and group class and letting to self -express was a good chance for them and they were  encouraged continue.However, your question prompted  me to investigate this subject in  follow-up.thanks   

Hi Kate

I think patient’s coping style is important factor,  especially with those who deny  their disease

Regards

We are about finished with this work and the bottom line is that we could not find strong predictors.  Not saying they are not there but if true it means that we need to design our interventions in a way that each individual feels comfortable self-tailoring them to their own needs.   Many thank all

Dear Kate,

Few years ago we studied the effects of chronic disease self-management program (CDSMP) in older adults living in the community and evaluated the potential factors affecting the effects of the program. We found that oldest-old, less educated and frailer participants benefited more from the program. In addition, the characteristics of the program leader (either lay persons or health professionals) did not affect the program outcomes. Although our findings may not be directly related to your question, the implication of our studies may help to disseminate the program to a wider audience and reach those underprivileged people who have very little health care resources and are in needs of health education and self-management support. 

Hope this piece of information helps you. 

Best regards,

Wayne

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