Tomando Control de su Salud is 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. Spanish-speaking people with different chronic health problems attend together. Workshops are facilitated by two trained leaders, one or both of whom are non-health professionals with a chronic diseases themselves. All workshops are given in Spanish without translators.
The Program is not a translation of the Chronic Disease Self-Management Program, but developed separately in Spanish. Subjects covered are similar, but they are presented in ways that are culturally appropriate. Subjects include: 1) techniques to deal with problems such as frustration, fatigue, pain and isolation, 2) appropriate exercise for maintaining and improving strength, flexibility, and endurance, 3) appropriate use of medications, 4) communicating effectively with family, friends, and health professionals, 5) healthy eating, 6) appropriate use of the health care system, and, 7) how to evaluate new treatments. Participants in the workshop may purchase 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 disease-specific education such as Better Breathers, cardiac rehabilitation, or diabetes instruction. In addition, many people 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 five year research grant from the National Institute of Nursing Research (NINR) and the State of California Tobacco-Related Diseases office. The purpose of the research was to develop and evaluate, through a randomized controlled trial, a community-based spanish-language self-management program that assists Latinos with chronic illness. The study was just completed. Principle investigator for the research project was Kate Lorig, Dr.P.H., Stanford Associate Professor of Medicine. The Program was written by Dr. Lorig, Virginia González, M.P.H., and Maria Hernández Marin, all of the Stanford Patient Education Research Center. Ms. González and Ms. Marin also served as integral members of the research team.
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 chronic disease, 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?
Leader trainings for the Spanish program are 4½ days. See our Training Calendar 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. 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.