Providing Care and Completion of Chronic Disease Self-Management Program

Background and Purpose: For American adults aged 65 and above, 85.5% are reported to have one or more chronic health conditions (Ward, Schiller, & Goodman, 2014). Family caregivers for older adults are often dealing with their own chronic conditions while assisting in management of the health conditions of their loved ones. Having knowledge and skills of chronic disease self-management will benefit both themselves and their care recipients. Chronic Disease Self-Management Program (CDSMP) by Stanford University is the most well-known program with multiple health benefits to participants. Despite many studies on the factors associated with CDSMP workshops completion, largely uninvestigated is the attendance of caregivers to the CDSMP workshop and how it is different from non-caregivers.

The purpose of this study is to understand the association between providing care (being a caregiver) and completion of CDSMP workshops, and specific differences between caregivers and non-caregivers in factors associated with completion of CDSMP workshops. The study hypothesis is that participants who providing care will more likely to complete CDSMP workshop compared with those who do not.

Methods: This study used baseline cross-sectional data collected directly from all the participants of CDSMP workshops in New York State from 2012 to 2015. At the beginning of each workshop, all participants completed a standardized information survey on their demographics, chronic conditions, living arrangement, disability status, caregiving roles and health insurance information. Total sample include individuals with chronic conditions and caregivers (aged 18 and older, N=2,685).  Multi-level logistic regression analysis was conducted by Stata version 13. Dependent variable is completion of workshops (attended four or more of sessions, 76% completers), and independent variable is measured by whether participants provided care/assistance to family member or friends with long-term illness or disability (31% caregivers). Individual-level (age, gender, race/ethnicity, living arrangement, education, number of chronic conditions and disability) and workshop-level characteristics (class size, weekday offered, delivery site urbanity, and type) were controlled.

Results: The results shown that caregivers were more likely to complete workshop compared with non-caregivers (OR=1.271, p<.05). More chronic conditions, college education and above, smaller class size were all associated with better completion of participants. For caregivers, only having four years of college or above education (OR=2.444, P<0.01) and attending workshops held in Senior Centers/Area Agency on Aging (OR=3.921, P<0.05) and faith-based organizations (OR=5.185, P<0.05) was associated with higher workshop completion.

Conclusions and Implications: Family caregivers appeared to have stronger motivation to attend chronic disease self-management workshops, and the factors that influence the workshop completion for caregivers are different from that for non-caregivers. Future research should investigate whether being accompanied by a caregiver on the workshops increases completion rates for both caregivers and care recipients. Better caregivers’ enrollment in CDSMP workshops may improve the management of chronic conditions and promote aging in place. Social workers and health professionals should refer more caregivers to CDSMP workshops. Agencies offering CDSMP should encourage caregivers to attend by picking up appropriate sites, and making special arrangements for caregivers with lower education level.