Programa de Manejo Personal de la Diabetes a workshop given two and a half hours, once a week, for six weeks, in community settings such as senior centers, churches, libraries and hospitals. Workshops are facilitated by two trained leaders, one or both of whom are non-health professionals with diabetes themselves. All workshops are given in Spanish without translators.
Spanish-speaking people with type 2 diabetes attend the program in groups of 12-16. Workshops are facilitated from a highly detailed manual by two trained leaders, one or both of whom are peer leaders with diabetes themselves. Participants may also bring a family member or friend. The Stanford Patient Education Research Center received a grant from the National Institute of Nursing Research (NINR) for the randomized, controlled study. The principal investigator was Kate Lorig and the project manager was Frank Villa.
Subjects covered include: 1) techniques to deal with the symptoms of diabetes, fatigue, pain, hyper/hypoglycemia, stress, and emotional problems such as depression, anger, fear and frustration; 2) appropriate exercise for maintaining and improving strength and endurance; 3) healthy eating 4) appropriate use of medication; and 5) working more effectively with health care providers. Participants will make weekly action plans, share experiences, and help each other solve problems they encounter in creating and carrying out their self-management program. Physicians and other health professionals both at Stanford and in the community have reviewed all materials in the workshop.
Each participant in the workshop receives a copy of the companion book, Tomando Control de su Salud: Una guía para el manejo de las infermedades del corazón, diabetes, asma, bronquitis, enfisema y otros problemas crónicos, an audio relaxation tape, Casete de Relajación, and an audio exercise tape with booklet, ¡Hagamos ejercicio! All materials are in Spanish.*
It is the process in which the program is taught that makes it effective. Classes are highly participative, where mutual support and success build the participants’ confidence in their ability to manage their health and maintain active and fulfilling lives.
Does the Program replace existing programs and treatments?
The Program will not conflict with existing programs or treatment. It is designed to enhance regular treatment and diabetes education. In addition, many people with diabetes have more than one chronic condition. The program is especially helpful for these people, as it gives them the skills to coordinate all the things needed to manage their health, as well as to help them keep active in their lives.
How was the Program developed?
The Department of Medicine in the School of Medicine at Stanford University received a research grant from the National Institute of Nursing Research (NINR). The purpose of the research was to develop and evaluate, through a randomized controlled trial, a community-based spanish-language diabetes self-management program that assists Latinos with type 2 diabetes. The study was completed in 2007. Principle investigator for the research project was Kate Lorig, Dr.P.H., Stanford Associate Professor of Medicine. Frank Villa, M.P.H. was the project manager.
The process of the program was based on the experience of the investigators and others with self-efficacy, the confidence one has that he or she can master a new skill or affect one’s own health. The content of the workshop was the result of focus groups in Spanish with people with diabetes, in which the participants discussed which content areas were the most important for them.
How was the Program evaluated?
Over 500 Spanish-speaking people with heart disease, lung disease, or diabetes participated in an randomized, controlled test of the Program, and were followed for one year. We looked for changes in many areas: health status (disability, social/role limitations, pain and physical discomfort, fatigue, shortness of breath, health distress, self-rated general health), health care utilization (visits to physicians, visits to emergency department, hospital stays, and nights in hospital), self-efficacy (confidence to perform self-management behaviors, confidence to manage disease in general, confidence to achieve outcomes), and self-management behaviors (exercise, cognitive symptom management, mental stress management/relaxation, communication with physician).
What were the results?
At four months, the participants, as compared with usual-care control subjects, demonstrated improved health status, health behavior, and self-efficacy, as well as fewer emergency room visits. At one year, the improvements were maintained and remained significantly different from baseline condition.**
How can my facility offer the Program?
Trainings for Spanish-speaking representatives of health care organizations are 4½ days. We also offer a cross-training at Stanford for those who have already been trained to offer the Spanish Chronic Disease Self-Management Program, Tomando Control de su Salud, as well as a cross training for both Spanish programs together . See our Training Page for more information.
The Program and all training are done in Spanish without interpreters. It is required that leaders and trainers both speak and read Spanish fluently. Patient participants taking the Program at your facility must speak Spanish, but it is not necessary that they read Spanish.
*For information on these materials, see the materials page.
**Reported in: Lorig KR, Ritter PL, González VM. Hispanic Chronic Disease Self-Management: A Randomized
Community-based Outcome Trial. Nursing Research, 52(6):361-9, 2003.
*Tomando Control de su Salud: Una guía para el manejo de las infermedades del corazón, diabetes, asma, bronquitis, enfisema y otros problemas crónicos (second edition) by González, Hernández-Marin, Lorig, Sobel,Laurent, and Minor (2007), and both Casete de Relajación and ¡Hagamos ejercicio! audio Cds/tapes can be ordered from Bull Publishing.