Methodology
To supplement a limited evidence base, we examined the
variation in the current state of self-management programs to better understand
the programming options currently in use. We did so by reviewing the recent
literature on existing programs and interviewing a diverse group of key experts
in the field.
Literature Review
We conducted a systematic literature search of multiple
bibliographic databases, including MEDLINE®, Cinahl, and the New York Academy of
Medicine (NYAM) Grey Literature Collection, Sociological Abstracts, and Social
Services Abstracts. Search terms included "self-management," "disease
management," "chronic care management," "self-efficacy," "self-care,"
"telehealth," "telemonitor," "telemedicine," and "chronic disease,"
"chronic illness," "high risk obstetrics or pregnancy," "diabetes," "asthma,"
"health failure," "depression," "depressive disorder," and "program" and "support." We limited the search to English-language articles published in
the last 5 years and studies conducted in the United States.
The search netted approximately 900 citations, which were
screened first by topic and then by abstract and full review. To be included in
our study, articles had to provide information on self-management support
program design in real-world settings or describe evaluation measures used in real-world
programs or in research on such programs. Reviews of the effectiveness of
self-management support interventions were examined for the purpose of
gathering background information; 80 articles met these inclusion criteria.
From these studies, we abstracted information on the research design,
self-management support program or intervention features, evaluation measures,
and study setting and population.a
Interviews with Self-Management Support Experts
We interviewed 44 people knowledgeable about self-management
support programs provided through health plans, insurers, employers, public
providers, and payers. To produce a list of initial interviewees, we turned to
our existing network of experts in the area of chronic disease self-management
support, contacts from the 2005 Disease Management Leadership Forum, and the
annual lists of DMAA awards for program performance in the field of disease
management.37 A "snowball" approach was used to expand this group of interviewees with
additional experts identified either in the initial interviews or through the
literature review. We identified 55 people as potential interviewees; 44
consented to be interviewed.
We developed a comprehensive interview guide from which we
selected items appropriate to each interviewee's expertise. The interview guide
was structured to address the multiple domains of self-management support
programming choices. Interviewees were recruited by email and interviewed by
telephone. Each interview lasted approximately 60 minutes and was conducted by
a two-person team consisting of an investigator and a research associate. The
RAND Human Subjects Protection Committee approved the recruitment and consent
procedures, interview guide, and data safeguarding procedures. Web site
searches, articles identified in the literature review, and materials obtained
from interviewees were used to supplement the interview data.
a. The form used to abstract these data is available from the author on request:
mpearson@rand.org.
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