Research evidence for different cultural groups

Much of Lorig’s initial research was conducted on predominantly white patients⁽¹⁾ and therefore application and effectiveness of programs in a range of ethnic and social groups was relatively unknown. Recent investigations however validate its effectiveness. A study by Swerrisen in Victoria, Australia has shown successful health outcomes when the CDSMP has been implemented with patients from Vietnamese, Chinese, Italian and Greek backgrounds.⁽²⁾ Participants in the intervention group had significantly better outcomes on energy, exercise, symptom management, self-efficacy, general health, pain, fatigue and health distress. Similar changes have been shown when the CDSMP has been delivered to patients in Shanghai and Hong Kong.^(3,4)

A pilot program for Aboriginal people with type 2 diabetes using the Flinders model of self-management care planning was conducted by Aboriginal Health Workers (AHW). The process was shown to be acceptable and appropriate in this setting with improved self-management outcomes.⁽⁵⁾

As there are few ‘off-the shelf’ products for specific cultural groups, adaptation of existing models needs to occur. For example, the LIFE Course was modified from the CDSMP and has been successfully applied to Aboriginal and Torres Straight Islander people of Australia in Port Augusta, South Australia. This model may need to be further adjusted for other Aboriginal groups across Australia.⁽⁶⁾

An asthma self-management program based in a Maori community improved long-term benefits; reduced asthma morbidity, cultural affirmation, improved access to other health services, a greater sense of control for participants and positive impacts on the extended family. The study offers support for providing public health services for indigenous communities that take a partnership approach, utilise community expertise and is delivered in a way that is consistent with each community's cultural processes.⁽⁷⁾

The popao (outrigger canoe) has been used as a metaphorical model for the shared journey towards recovery of mental health service users and professionals in a Pacific (Tongan) setting.⁽⁷⁾ Patients use their understanding of the purpose of the popao and how it functions in its environment as a framework to make sense of their own mental health recovery plan. It is most applicable to the environment and is hoped to be a founding model for all other Pacific ethnic groups.

Summary of research studies

To view the studies supporting self-management programs for different cultural groups please click here.

Patient evidence to support self-management

The case study on the opening page of this module demonstrated the positive impact of self-management. Many patients have a wealth of personal life experience of coping and recovering from mental illness, which can provide support to self-management.

Patient self-management experience

The patient in the following audio extract explains the positive health outcomes of working with a psychiatrist who gave her responsibility to make decisions in the management of her own mental illness and through collaborative goal setting, allowed the patient to achieve her ambitions.

Listen to the audio version of the case study.
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View the text description of the case study.

References

1. Greenhalgh T, Greenhalgh T. Patient and public involvement in chronic illness: beyond the expert patient. British Medical Journal 2009;338:b49.
2. Swerissen H, Belfrage J, Weeks A, et al. A randomised control trial of a self-management program for people with a chronic illness from Vietnamese, Chinese, Italian and Greek backgrounds. Patient Education and Counseling 2006; 64(1-3):360-8.
3. Siu A, Chan C, Poon P, Chui D, Chan S. Evaluation of the chronic disease self-management program in a Chinese population. Patient Education and Counseling 2007;65(1):42-50.
4. Fu D, Fu H, McGowan P, et al. Implementation and quantitative evaluation of chronic disease self-management programme in Shanghai, China: randomized controlled trial. Bulletin of the World Health Organisation 2003;81(3):174-82. Available from: http://www.mrw.interscience.wiley.com/cochrane/clcentral/articles/671/CN-00437671/frame.html.
5. Battersby M, Ah Kit J, Prideaux C, Harvey P, Collins JP, Mills P. Research implementing the Flinders Model of Self-management Support with Aboriginal People who have diabetes: findings from a pilot study. Australian Journal of Primary Health 2008;14(1):66-74.
6. Warren K, Coulthard F, Harvey P. Elements of successful chronic condition self-management program for Indigenous Australians. Available at: http://www.abc.net.au/rural/events/ruralhealth/2005/papers/selfmanagement.pdf
7. Ratima MM, Fox C, Fox B, Te Karu H, Gemmell T, Slater T,  D'Souza WJ, Pearce NE. Long-term benefits for Maori of an asthma self-management program in a Maori community which takes a partnership approach. Australian & New Zealand Journal of Public Health 1999;23(6):601-5.
8. Fotu M, Tafa T. The Popao Model: A Pacific recovery and strength concept in mental health. Pacific Health Dialogue 2009;15(1):64-70

 

Continue to Module 1.6: Collaboration and Self-management.