Griffiths Chris, Motlib Justhna, Azad Abdul, Ramsay Jean, Eldridge Sandra, Feder Gene, Khanam Rowshan, Munni Rafia, Garrett Myra, Turner Andy, Barlow Julia
Interdisciplinary Research Centre in Health, School of Health & Social Sciences, Coventry University.
Br J Gen Pract. 2005 Nov;55(520):831-7.
Reducing the impact of chronic disease in minority ethnic groups is an important public health challenge. Lay-led education may overcome cultural and language barriers that limit the effectiveness of professionally-led programmes. We report the first randomised trial of a lay-led self-management programme - the Chronic Disease Self-Management Programme (CDSMP) (Expert Patient Programme) - in a south Asian group.
To determine the effectiveness of a culturally-adapted lay-led self-management programme for Bangladeshi adults with chronic disease.
Randomised controlled trial.
Tower Hamlets, east London.
We recruited Bangladeshi adults with diabetes, cardiovascular disease, respiratory disease or arthritis from general practices and randomised them to the CDSMP or waiting-list control. Self-efficacy (primary outcome), self-management behaviour, communication with clinician, depression scores, and healthcare use were assessed by blinded interviewer-administered questionnaires in Sylheti before randomisation and 4 months later.
Of the 1363 people invited, 476 (34%) agreed to take part and 92% (439/476) of participants were followed up. The programme improved self-efficacy (difference: 0.67, 95% confidence interval [CI] = 0.08 to 1.25) and self-management behaviour (0.53; 95% CI = 0.01 to 1.06). In the 51% (121/238) of intervention participants attending three or more of the 6-weekly education sessions the programme led to greater improvements in self-efficacy (1.47; 95% CI = 0.50 to 1.82) and self-management behaviour (1.16; 95% CI = 0.50 to 1.82), and reduced HADS depression scores (0.64; 95% CI = 0.07 to 1.22). Communication and healthcare use were not significantly different between groups. The programme cost pound123 (181) per participant.
A culturally-adapted CDSMP improves self-efficacy and self-care behaviour in Bangladeshi patients with chronic disease. Effects on health status were marginal. Benefits were limited by moderate uptake and attendance.
减少慢性病对少数族裔群体的影响是一项重大的公共卫生挑战。由非专业人员主导的教育可能会克服限制专业人员主导项目效果的文化和语言障碍。我们报告了在南亚群体中进行的首个由非专业人员主导的自我管理项目——慢性病自我管理项目（CDSMP）（专家患者项目）的随机试验。
确定针对患有慢性病的孟加拉国成年人的经过文化调适的由非专业人员主导的自我管理项目的效果。
随机对照试验。
伦敦东部的陶尔哈姆莱茨区。
我们从全科医疗诊所招募患有糖尿病、心血管疾病、呼吸系统疾病或关节炎的孟加拉国成年人，并将他们随机分为CDSMP组或等待名单对照组。在随机分组前和4个月后，由盲法访谈者通过问卷对自我效能感（主要结果）、自我管理行为、与临床医生的沟通、抑郁评分和医疗保健使用情况进行评估，问卷使用锡尔赫蒂语。
在1363名被邀请者中，476人（34%）同意参与，92%（439/476）的参与者接受了随访。该项目提高了自我效能感（差异：0.67，95%置信区间[CI]=0.08至1.25）和自我管理行为（0.53；95%CI=0.01至1.06）。在参加了6次为期一周的教育课程中3次或更多次的51%（121/238）干预组参与者中，该项目使自我效能感（1.47；95%CI=0.50至1.82）和自我管理行为（1.16；95%CI=0.50至1.82）有了更大改善，并降低了医院焦虑抑郁量表（HADS）抑郁评分（0.64；95%CI=0.07至1.22）。两组之间在沟通和医疗保健使用方面没有显著差异。该项目每位参与者的成本为123英镑（181美元）。
经过文化调适的CDSMP提高了患有慢性病的孟加拉国患者的自我效能感和自我护理行为。对健康状况的影响微乎其微。受益受到参与率和出勤率中等的限制。
