Home-Based, Peer-Led Chronic Illness Self-Management Training: Findings From a 1-Year Randomized Controlled Trial

Anthony Jerant; Monique Moore-Hill; Peter Franks

doi:10.1370/afm.996

Article Figures & Data

Figures

Tables
Additional Files

Download figure
Open in new tab
Download powerpoint
Figure 1.
Flow of participants through the study.
CES-9 = Center for Epidemiologic Studies Depression Scale, 10-item version; HAQ = Health Assessment Questionnaire; HIOH = Homing in on Health; SF-36 = Medical Outcomes Study 36-item short-form health survey (SF-36).

View popup

Table 1.

Characteristics of Participants by Study Group

Characteristic	Home (n=138)	Telephone (n=139)	Usual Care (n=138)
CES-D = Center for Epidemiologic Studies Depression Scale, 10-item version; EQ-5D = EuroQol-5D; EQ VAS = EuroQol Visual Analog Scale; GH = Medical Outcomes Study 36-item short-form health survey (SF-36) general health subscale; HAQ = Health Assessment Questionnaire; PCS-36 = SF-36 physical component summary score; MCS-36 = SF-36 mental component summary score; PT/PP = pills taken/pills prescribed during the 7 days before data collection.
^a Percentages exceed 100 because many participants had more than 1 condition.
Age, years, mean (SD)	59.8 (11.2)	61.2 (11.6)	60.1 (11.7)
Sex, n (%)
Female	108 (78)	109 (78)	104 (75)
Race/ethnicity, n (%)
Non-Hispanic White	103 (75)	110 (79)	115 (83)
Black	20 (15)	11 (8)	15 (11)
Other	14 (9)	14 (10)	7 (5)
Declined to answer	1 (1)	4 (3)	1 (1)
Education level, n (%)
High school or less	19 (14)	20(14)	22 (16)
Some college	53 (38)	50 (36)	58 (42)
College graduate or greater	66 (47)	65 (47)	57 (41)
Declined to answer	0 (0)	4 (3)	1 (1)
Income level, n (%)
<40,000	41 (30)	42 (31)	44 (32)
40,000–79,999	42 (30)	37 (27)	43 (31)
>80,000	22 (16)	27 (20)	22 (16)
Declined to answer	33 (24)	33 (24)	29 (21)
Married, n (%)	79 (57)	79 (57)	76 (55)
Chronic conditions, n (%)
1	55 (40)	72 (51)	43 (31)
2	51 (37)	40 (29)	65 (47)
3	18 (13)	21 (15)	21 (15)
>4	14 (10)	6 (4)	9 (7)
Self-reported diagnoses, n (%)^a
Arthritis	83 (60)	73 (52)	77 (55)
Depression	59 (43)	64 (46)	70 (51)
Diabetes	64 (46)	50 (36)	58 (42)
Asthma	34 (25)	25 (18)	39 (28)
Chronic lung disease	15 (11)	11 (8)	17(12)
Congestive heart failure	17 (12)	17 (12)	14 (10)
Uninsured, n (%)	3 (2)	5 (4)	2 (2)
Baseline status of outcomes, mean score (SD)
Self-efficacy	7.0 (1.8)	7.0 (1.7)	7.1 (1.8)
PCS-36	33.6 (12.0)	33.3 (12.4)	34.4 (11.0)
MCS-36	45.6 (14.2)	45.3 (13.7)	45.8 (13.7)
GH	47.2 (22.0)	48.1 (24.9)	50.2 (23.2)
EQ-5D	0.74 (0.18)	0.73 (0.18)	0.75 (0.16)
EQ VAS	64.3 (18.5)	66.6 (19.1)	68.4 (18.6)
HAQ	0.92 (0.68)	0.85 (0.74)	0.82 (0.65)
CES-D	9.5 (7.1)	9.8 (6.5)	9.5 (7.1)

View popup

Table 2.

Six-Week, 6-Month, and 1-Year Self-Efficacy and Primary and Secondary Outcome Scores by Study Group

Outcome	Home (n=138)	Telephone (n=139)	Usual Care (n=138)
CES-D = Center for Epidemiologic Studies Depression Scale, 10-item version; EQ-5D = EuroQol-5D; EQ VAS = EuroQol Visual Analog Scale; GH = SF-36 = Medical Outcomes Study 36-item short-form health survey (SF-36) general health subscale; HAQ = Health Assessment Questionnaire; MCS-36 = SF-36 mental component summary score; PCS-36 = SF-36 physical component summary score; PT/PP = pills taken/pills prescribed during the 7 days preceding data collection.
Intervention content delivery effectiveness
Self-efficacy score, mean (SD)
6 Weeks	7.6 (1.5)	7.2 (1.8)	7.2 (1.9)
6 Months	7.5 (1.6)	7.2 (1.8)	7.2 (1.7)
1 Year	7.4 (1.6)	7.3 (1.7)	7.2 (1.8)
Primary outcome
PCS-36 score, mean (SD)
6 Weeks	34.9 (11.9)	36.3 (11.6)	37.3 (11.1)
6 Months	36.2 (12.0)	37.5 (11.8)	37.2 (11.4)
1 Year	35.1 (12.2)	36.4 (12.3)	37.0 (11.6)
MCS-36 score, mean (SD)
6 Weeks	51.6 (12.1)	48.9 (12.3)	48.6 (12.8)
6 Months	49.6 (13.7)	46.1 (13.6)	48.0 (13.0)
1 Year	51.2 (12.1)	48.3 (12.0)	48.5 (12.9)
Secondary outcome
GH score, mean (SD)
6 Weeks	54.1 (21.4)	54.4 (23.4)	54.6 (25.0)
6 Months	53.8 (22.5)	53.5 (23.5)	54.4 (25.0)
1 Year	54.2 (23.1)	54.3 (22.9)	54.2 (24.1)
EQ-5D score, mean (SD)
6 Weeks	0.80 (0.17)	0.80 (0.17)	0.80 (0.17)
6 Months	0.82 (0.16)	0.81 (0.18)	0.80 (0.20)
1 Year	0.79 (0.18)	0.77 (0.20)	0.81 (0.17)
EQ VAS score, mean (SD)
6 Weeks	75.7 (18.5)	73.5 (18.9)	72.4 (19.7)
6 Months	74.6 (17.5)	73.0 (20.4)	72.9 (18.9)
1 Year	75.7 (15.2)	72.3 (20.1)	72.3 (18.9)
HAQ score, mean (SD)
6 Weeks	0.89 (0.70)	0.84 (0.71)	0.76 (0.64)
6 Months	0.88 (0.67)	0.85 (0.74)	0.80 (0.68)
1 Year	0.91 (0.71)	0.85 (0.71)	0.77 (0.64)
CES-D score, mean (SD)
6 Weeks	7.1 (6.0)	7.6 (5.4)	8.3 (6.5)
6 Months	7.5 (5.9)	9.2 (6.5)	8.2 (6.6)
1 Year	7.4 (6.3)	8.6 (6.1)	8.2 (6.9)
PT/PP, mean % (SD)
6 Weeks	93 (11)	92 (15)	93 (11)
6 Months	91 (16)	89 (18)	93 (13)
1 Year	94 (10)	93 (12)	91 (15)
Health care utilization at 1 year
Hospitalization, %	16 (–)	11 (–)	15 (–)
Expenditures, $, mean (SD)	14,105 (20,279)	12,422 (14,241)	11,493 (10,972)

Additional Files

Figures
Tables

The Article in Brief

Home-Based, Peer-Led Chronic Illness Self-Management Training: Findings From a 1-Year Randomized Controlled Trial

Anthony Jerant , and colleagues

Background Previous research suggests that peer-led self-management training improves chronic illness outcomes by strengthening patients' confidence to manage their illness. This study tests the effectiveness of an in-home self-management program for chronically ill patients.

What This Study Found Compared with usual care, a chronic disease self-management program delivered in the home led to more effective illness self-management at 6 weeks and at 6 months but not at 1 year. Neither the in-home program nor a similar program delivered by phone had significant effects on overall mental and physical health or on use of health care resources.

Implications

Peer-led chronic illness self-management programs appear to result in small to moderate, short-term effects on health outcomes, with no apparent effect on overall mental or physical health or health care expenditures.
These findings challenge previous suggestions that wider use of peer-led illness self-management programs would be cost-effective.