Study On Implementation Effectiveness And Sustainable Development Of Chronic Disease Self-Management In Shanghai

Today, noncommunicable diseases (NCDs) represent a leading threat to human health and development, causing about35million deaths each year-60%of all deaths globally-with80%in low-and middle-income countries. These diseases are preventable. Research has demonstrated that people who take the lead themselves in managing their chronic disease-with good support from health service providers have improved health and that incapacity is is reduced. Chronic disease self-management programme means that patients learn the skills necessary to take on active role in caring for their own chronic conditions and assume some medical and preventive tasks with the support of health professionals. The successful experiences from domestic and international researches indicated that patient-centered chronic disease self-management programme (CDSMP) is a cost-effective strategy to improve patients’health functioning and quality of life. Many countries such as, the United States, the British, Australia and Canada, have integrated self-management into primary health care gradually. In the second half year of2007, the Office of Patriotic Health Campaign Committee of Shanghai adopted the recommendation from the study of "community-based project of self-management of hypertension" by School of Public Health, Fudan University. There were totally5048villages,9762groups,166158people participating in these activities, which covered99.55%streets,95.93%villages till2010. Under the principles of doctor-patient cooperation, mutual aid, self-management, CDSMP aims to create a supportive environment for chronic disease prevention and control. In order to make CDSMP sustainable, we have to combine the self-management support with the routine disease management and responsibility system of family doctors. In another aspect, Patriotic Health Campaign Committee system, as the main force of health education and health promotion, how to give full play to their own advantages, to overcome obstacles and shoulder the health education and the responsiblilty of the prevention and control of chronic disease, is the key to the sustainable development. This study would focus on the abve problems, around implementation effect, summarizes the present work experiences of success and the insufficiency to promote CDSMP sustainable development.GoalThe present study aim to sum up experience and effective method, explore the main influencing factors for the implementation effect, and provide the scientific basis on policy recommendation for CDSMP sustainable development and prevention and control for chronic disease.Targets·To evaluate CDSMP’s effectiveness and the influencing factors;·With the guide of ecological model, to analyze the operational status of CDSMP, main obstacles and opportunities, and to seek solutions from individual, interpersonal, community and organization four levels.SubjectsGroup members and group leaders from150self-management groups, members’ relatives, community residents and Patriotic Health Campaign Committee’stuff were randomized selected by stages.Contents1. Implementation and spread process for CDSMP in Shanghai2. Implementation effect of CDSMP in Shanghai3. Sustainable development study of CDSMP in ShanghaiMethodsA cross-sectional research design was applied. The quantitative and qualitative analysis was used in this research. The quantitative method involves questionnaire survey. The qualitative analysis included focus group discussion. We use descriptive and analytical assessment in data analysis, including descriptive analysis, univariate analysis, multivariate linear regression, binary logistic regression, ordinal logistic regression, social network analysis, multilevel analysis and Fault Tree Analysis (FTA).ResultsSection1Implementation and spread process for CDSMP in ShanghaiBased on the collection of the document provided by the Patriotic Health Campaign Committee office, we sum up the development process of CDSMP. The result showed that CDSMP as a community intervention experimental research becomes an action for prevention and control for chronic illness, is very successful. Powerful policy support, defined responsibilities of operation parties and active participation of relevant population are keys.Section2Implementation effectiveness of CDSMP in Shanghai1.5Core SkillsThe results showed that63.6%of group members have sufficient interactive health literacy. The suvey of community residents indicated that the percent of residents who participate in the chronic disease self-management groups with sufficient interactive health literacy is higher than those who did not attend. Gender, age, education, having chronic disease or not, self-efficacy are related with interactive health literacy score.2. Disease and Behavior management17.1%of members don’t have any chronic disease in self-management groups at present. In all chronic disease group members have, hypertension has the highest morbidity. Others are arthritis, cerebrovascular disease and diabetes in sequence. The control rate of hypertension is79.3%. Gender and social support are related with the control of hypertension.34.6%of group members increase their phycial activity significantly, and45.1%increase phycial activity slightly.32.5%of members increase their vegetable and fruit intake significantly and46.0%increase intake slightly.24.9%and58.0%of members decrease their salt intake significantly and slightly respectively.28.3%and55.4%of members decrease their oil intake significantly and slightly respectively. Women are better in life behavior improvement than men.3. Emotional managementThe qualitative analysis showed that, after members participated in self-management group, mutual exchange and having a good mood are biggest harvest. The quantitative results showed that education, self-efficacy, interactive health literacy and social support are influencing factors for resilience.4. Social and Role managementThe quantitative and qualitative analysis indicated that group members participate in community activities widely.58.8%of members take part in volunteer organization,50.6%take part in activities organized by residents’committees or street agency,47.8%participate in interest activities.Partial correlation analysis presented that structural social capital is positively correlated with cognitive social capital. The more members participate in social activites, the higher reciprocity and trust degree they will have. And the social role limitation is related with structural social capital, the social support members obtain is related with cognitive social capital.Section3Sustainable study of CDSMP in Shanghai1. Individual levelChronic Disease self-management groups have been enriched in the content through the various activities. Members are satisfied with the efforts taken by group leader, instruct doctor and Neighborhood cadre, also satisfied with the group activities. Interaction, consulation, fitness activities, seminar, tea party, healthy cooking are regular activities. Higher demand and lack of limitation and funding are the main problems facing at present.2. Interpersonal level77.4%of community residents have heard of self-management group.50.9%of community residents would like to attend. Focus group interview on the members’ family indicated that almost all the family members support self-management group, they all see group members’improvement in physical and emotional health. And they also received health knowledge from members. Social network analysis on15self-management groups showed that group leader are the social network’s centers in9groups’network graph, ordinary members are the centers in the other6groups’ network graph. As the center and intermediary of network, group leaders transfer information, emotion and trust. They also play the role of bridge. Objective indicators such as blood pressure control, structural social capital levels in leader-centered group are better than other groups.While subjective indicators such as cognitive social capital, resilience and self-perceived health status in member-centered group are better than other groups.3. Community levelThe main problems in this level are lack of the abilities of obtaining resources, limitation of external support channel, lack of substantive appraisal system and clear rewards and punishments mechanism, lack of connection with others and lack of interaction among groups or communities. Group leaders also need further training. In the150groups,130groups (87.3%) have realized existing problems and have basic community ability,2groups have higer degree of community ability. Based on the community empowerment as a5point continuum, Community empowerment’ phrase of CDCMP enters a stage from small groups to community organizations.4. Organization level In individual health promotion capacity, Patriotic Health Campaign Committee’stuff have already understood health promotion basic knowledge although they aren’t medical professionals. But lack of practical skills and enough time to carry out in-depth work is a popular problem. The strength of individual capacity is attitude, the weakness is resource. In organizational health promotion capacity, the whole organization system has paid great attention with the work but lack of policy security. Lack of human resources goes against health promotion long-term planning. The strength of organizational capacity is commitment, the weakness is resource. In environmental health promotion capacity, stuff reported that government’s input is insufficient. Residents’health consciousness has been raised, but participation is not enough.The third obstacle is shortage of communication and coordination with other sectors. Public opinion and ideas, concept popularity are the strength and the weakness in environmental health promotion capacity respectively.5. Environmental factors’ influence on implementation effect of CDSMPTwo-level linear multilevel model was adopted to analyze the influence of community capacity and health promotion capacity on effect of CDSMP. The results indicated that health promotion capacity is positively related with members’ health status.6. Fault Tree Analysis on CDSMPThe main problem of four levels is lack of the resources and mechanism security. We should make great efforts in these two aspects. In the longer term, the attention of the government, involving self-management into primary health care and cultivation of health promotion team are the root of problem.ConclusionsThe implementation effectiveness of CDSMP in Shanghai is remarkable, and CDSMP has already had the base for the sustainable development. Group members are satisfied with the activities and efforts taken by group leaders and CDSMP is spreaded widely.Through the basic training and practice in the past few years, relevant personnel have the capacity to guarantee the implementation of CDSMP. Involvement in regular health services and continuous security of human resources and fund are the direction.