Decay of Impact After Self-management Education for People with Chronic Illnesses: Changes in Anxiety and Depression over One Year

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2013 Jun 21

PMID 23785418

Citations 3

Authors

M J Park

Joseph Green

Hirono Ishikawa

Yoshihiko Yamazaki

Akira Kitagawa

Miho Ono

Fumiko Yasukata

Takahiro Kiuchi

Affiliations

Soon will be listed here.

Abstract

Background: In people with chronic illnesses, self-management education can reduce anxiety and depression. Those benefits, however, decay over time. Efforts have been made to prevent or minimize that "decay of impact", but they have not been based on information about the decay's characteristics, and they have failed. Here we show how the decay's basic characteristics (prevalence, timing, and magnitude) can be quantified. Regarding anxiety and depression, we also report the prevalence, timing, and magnitude of the decay.

Methods: Adults with various chronic conditions participated in a self-management educational program (n = 369). Data were collected with the Hospital Anxiety and Depression Scale four times over one year. Using within-person effect sizes, we defined decay of impact as a decline of ≥0.5 standard deviations after improvement by at least the same amount. We also interpret the results using previously-set criteria for non-cases, possible cases, and probable cases.

Results: Prevalence: On anxiety, decay occurred in 19% of the participants (70/369), and on depression it occurred in 24% (90/369). Timing: In about one third of those with decay, it began 3 months after the baseline measurement (6 weeks after the educational program ended). Magnitude: The median magnitudes of decay on anxiety and on depression were both 4 points, which was about 1 standard deviation. Early in the follow-up year, many participants with decay moved into less severe clinical categories (e.g., becoming non-cases). Later, many of them moved into more severe categories (e.g., becoming probable cases).

Conclusions: Decay of impact can be identified and quantified from within-person effect sizes. This decay occurs in about one fifth or more of this program's participants. It can start soon after the program ends, and it is large enough to be clinically important. These findings can be used to plan interventions aimed at preventing or minimizing the decay of impact.

Citing Articles

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References

Lorig K, Ritter P, Villa F, Piette J . Spanish diabetes self-management with and without automated telephone reinforcement: two randomized trials. Diabetes Care. 2007; 31(3):408-14. DOI: 10.2337/dc07-1313. View

Linden M . How to define, find and classify side effects in psychotherapy: from unwanted events to adverse treatment reactions. Clin Psychol Psychother. 2012; 20(4):286-96. DOI: 10.1002/cpp.1765. View

Riemsma R, Taal E, Rasker J . Group education for patients with rheumatoid arthritis and their partners. Arthritis Rheum. 2003; 49(4):556-66. DOI: 10.1002/art.11207. View

Gitlin L, Chernett N, Harris L, Palmer D, Hopkins P, Dennis M . Harvest health: translation of the chronic disease self-management program for older African Americans in a senior setting. Gerontologist. 2008; 48(5):698-705. PMC: 4091666. DOI: 10.1093/geront/48.5.698. View

Yip Y, Sit J, Wong D, Chong S, Chung L . A 1-year follow-up of an experimental study of a self-management arthritis programme with an added exercise component of clients with osteoarthritis of the knee. Psychol Health Med. 2008; 13(4):402-14. DOI: 10.1080/13548500701584030. View

Swerissen H, Belfrage J, Weeks A, Jordan L, Walker C, Furler J . A randomised control trial of a self-management program for people with a chronic illness from Vietnamese, Chinese, Italian and Greek backgrounds. Patient Educ Couns. 2006; 64(1-3):360-8. DOI: 10.1016/j.pec.2006.04.003. View

Lorig K, HOLMAN H . Long-term outcomes of an arthritis self-management study: effects of reinforcement efforts. Soc Sci Med. 1989; 29(2):221-4. DOI: 10.1016/0277-9536(89)90170-6. View

McArdle J, Ferrer-Caja E, Hamagami F, Woodcock R . Comparative longitudinal structural analyses of the growth and decline of multiple intellectual abilities over the life span. Dev Psychol. 2002; 38(1):115-42. View

Cappelleri J, Bushmakin A . Interpretation of patient-reported outcomes. Stat Methods Med Res. 2013; 23(5):460-83. DOI: 10.1177/0962280213476377. View

10.

Smith L, Bosnic-Anticevich S, Mitchell B, Saini B, Krass I, Armour C . Treating asthma with a self-management model of illness behaviour in an Australian community pharmacy setting. Soc Sci Med. 2007; 64(7):1501-11. DOI: 10.1016/j.socscimed.2006.11.006. View

11.

Barlow J, Turner A, Swaby L, Gilchrist M, Wright C, Doherty M . An 8-yr follow-up of arthritis self-management programme participants. Rheumatology (Oxford). 2008; 48(2):128-33. DOI: 10.1093/rheumatology/ken429. View

12.

Glasgow R, Toobert D, Hampson S, Strycker L . Implementation, generalization and long-term results of the "choosing well" diabetes self-management intervention. Patient Educ Couns. 2002; 48(2):115-22. DOI: 10.1016/s0738-3991(02)00025-3. View

13.

Caplin D, Creer T . A self-management program for adult asthma. III. Maintenance and relapse of skills. J Asthma. 2001; 38(4):343-56. DOI: 10.1081/jas-100000263. View

14.

Park M, Green J, Ishikawa H, Kiuchi T . Hidden decay of impact after education for self-management of chronic illnesses: hypotheses. Chronic Illn. 2012; 9(1):73-80. PMC: 3697900. DOI: 10.1177/1742395312453351. View

15.

Haas M, Groupp E, Muench J, Kraemer D, Brummel-Smith K, Sharma R . Chronic disease self-management program for low back pain in the elderly. J Manipulative Physiol Ther. 2005; 28(4):228-37. DOI: 10.1016/j.jmpt.2005.03.010. View

16.

Wyrwich K, Bullinger M, Aaronson N, Hays R, Patrick D, Symonds T . Estimating clinically significant differences in quality of life outcomes. Qual Life Res. 2005; 14(2):285-95. DOI: 10.1007/s11136-004-0705-2. View

17.

Lorig K, Ritter P, Laurent D, Plant K . Internet-based chronic disease self-management: a randomized trial. Med Care. 2006; 44(11):964-71. DOI: 10.1097/01.mlr.0000233678.80203.c1. View

18.

Siu A, Chan C, Poon P, Chui D, Chan S . Evaluation of the chronic disease self-management program in a Chinese population. Patient Educ Couns. 2006; 65(1):42-50. PMC: 7135159. DOI: 10.1016/j.pec.2006.04.013. View

19.

Osborne R, Elsworth G, Whitfield K . The Health Education Impact Questionnaire (heiQ): an outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions. Patient Educ Couns. 2007; 66(2):192-201. DOI: 10.1016/j.pec.2006.12.002. View

20.

Franks P, Chapman B, Duberstein P, Jerant A . Five factor model personality factors moderated the effects of an intervention to enhance chronic disease management self-efficacy. Br J Health Psychol. 2008; 14(Pt 3):473-87. PMC: 2745728. DOI: 10.1348/135910708X360700. View