FAQs section two

Section 2: About Self-Management Education and Physical Activity Interventions

This section covers questions providers may ask about chronic disease self-management education and physical activity interventions. Marketers should review these FAQs as part of their preparation for conducting an outreach visit. These FAQs are designed to complement and expand upon information in the marketing guide, scripts, and fact sheets.

• What are chronic disease self-management education and physical activity interventions?
• How can self-management education and physical activity classes help people with chronic disease?
• How will providers know which interventions to recommend?
• How were the interventions developed?
• Are there any commercial or marketing tie-ins with the classes?
• How much do classes cost? Are there subsidies available for people who cannot afford class fees?
• Do participants need to purchase any special equipment or materials?
• Where are classes offered?
• What is the time commitment for participating in these classes?
• What are the qualifications of the class instructors?
• Are classes offered in languages other than English?
• Is there scientific evidence supporting the use of these interventions?
• How can providers and their patients learn more about chronic disease self-management education and physical activity programs?

What are chronic disease self-management education and physical activity interventions?

Community-based self-management education and physical activity interventions are effective, convenient, affordable options for helping people manage chronic disease symptoms and improve the quality of their lives.

Self-management education classes and workshops offer instruction on day-to-day strategies for managing and coping with arthritis and other chronic health conditions. They cover topics such as techniques for dealing with pain, fatigue, and physical limitations; appropriate exercise and medication use; effective communication with family, friends, and physicians; and proper nutrition.

Physical activity interventions teach a range of exercises—balance, stretching techniques, endurance and strength training, and low-impact conditioning exercise. Classes are designed to improve flexibility, joint range of motion, balance, endurance, and strength, and can be tailored to different skill and disability levels. They also teach behavioral skills such as goal-setting, problem-solving, and overcoming barriers.

How can self-management education and physical activity classes help people with chronic disease?

The CDC Arthritis Program has identified interventions shown to help reduce symptoms of arthritis and other chronic diseases so they can feel better, more independent, and more confident in managing their health. Benefits of the interventions include reduced pain and fatigue, increased physical activity, and improved mood, range of motion, psychosocial functioning, and quality of life. Improvements in symptoms and quality of life may translate to more satisfied patients. There is evidence that the beneficial effects of some interventions last well after the last class—for some programs, up to 12 months after completion.

How will providers know which interventions to recommend?

The materials you leave behind for providers and patients include information about the course content, intended audience, and documented benefits of each intervention. Encourage providers to use this information to determine which of the interventions offered would be most appropriate for a specific patient.

The “Who is it for?” section of each provider intervention fact sheet for providers gives general guidance by noting who the classes were designed for. Some programs are geared towards a particular type of arthritis; for example, the techniques taught in Fit and Strong! classes target osteoarthritis in the lower extremities. Other programs, such as the Chronic Disease Self-Management Program and Active Living Every Day, can benefit people with a variety of chronic conditions. When recommending an intervention, providers should consider factors such as a patient’s physical and disease status, current physical activity levels, and other health concerns, as well as his or her lifestyle, learning style (for example, whether the patient prefers group activities or self-study), transportation options and ability to afford course fees.

Providers will also want to consider a particular patient’s interests and health needs. The provider intervention fact sheet for providers and the patient brochure (Take Charge! Managing Your Health) describe the goals and content of each course. Encourage providers to use this information to help patients find a class that suits their needs and learning style. For example, patients who prefer self-study or who are unable to attend self-management education workshops in person may prefer to use The Arthritis Toolkit.

Other factors for providers to consider when helping patients select an intervention are the location of classes, available transportation, and course fees. You will customize the fact sheets with this information to help patients and providers choose accessible and affordable options.

How were the interventions developed?

The interventions supported by CDC were designed by reputable organizations. These include research groups at Stanford University, University of Washington, and University of Illinois at Chicago, and organizations such as the Arthritis Foundation. Some of the interventions began as research projects while others were developed in the field. The content of the programs is based on current evidence and practice guidelines regarding the use of self-management techniques to help manage arthritis or other chronic diseases. Ongoing research and evaluation informs updates to the program content.

Are there any commercial or marketing tie-ins with the classes?

No. The classes supported by the CDC Arthritis Program are not used to sell commercial products to participants. The self-management education interventions do supplement classes with materials such as relaxation audiotapes and books authored by experts in arthritis management. For example, the Arthritis Self-Management Program uses a text called The Arthritis Helpbook which was written by arthritis researchers at Stanford University. No added or hidden costs are applied for supplemental materials. For most classes, the registration fee covers their cost; some locations may use a lending library.

How much do classes cost? Are there subsidies available for people who cannot afford class fees?

The typical fee for a self-management education program is approximately $25–40 for a 6-week course. Physical activity programs cost about $1–4 per session and meet 1–3 times per week. In general, fees include the costs of materials—such as books—that are used in some classes. For people who can’t afford them, fees may be waived or subsidized or scholarships may be available. The Arthritis Foundation, for example, offers subsidies for those who can’t afford its classes.

Do participants need to purchase any special equipment or materials?

Textbooks, guides, and other supplemental materials are provided as needed and included in the course fees or available through a lending library. Weights and other equipment required for physical activity programs are provided by the facility where the class is held. Participants in physical activity programs will need to have clothing appropriate for class activities— for example, walking shoes or a swimsuit—and they may also want to bring their own towels and water bottles to class.

Where are classes offered?

Classes are offered at nearby locations such as community and senior centers, recreational facilities, health centers, schools, and YMCAs. The locations are generally accessible either by public transportation or by car. Free parking may be offered at some facilities. The classes you are promoting should be located within a 5–10 mile radius or 30-minute drive from the practices you are targeting. Remember that what is deemed an “acceptable” travel distance for participants will vary by an area’s density, transportation options, and local custom. For example, in many rural areas, it is not uncommon for people to travel 30 minutes or more to shop or participate in community events or activities. If you are promoting interventions in communities where people are willing to travel long distances, you can expand your outreach efforts to include providers who are located more than 10 miles from class locations.

What is the time commitment for participating in these classes?

Participants in self-management education programs can expect workshops to meet once a week for 2–2 ½ hours over a 6-week course. For those participating in physical activity programs, classes typically meet for 1 hour up to 3 times per week; course length ranges from 6–20 weeks with some programs offered on an ongoing basis. Participants may be asked to read materials or practice techniques outside of class. The ultimate goal of the programs is to encourage participants to incorporate the information they learn in class into their daily lives. Maintaining healthier behaviors after the programs have ended is a long-term commitment.

What are the qualifications of the class instructors?

All instructors are trained to deliver the specific classes they lead. Requirements vary by program, but most instructors receive at least 8 hours of training on the goals and components of the course. Some programs require up to 32 hours of specialized training. Some physical activity interventions require certification or licensure; for example, Fit and Strong! classes are led by either certified fitness instructors or licensed physical therapists. Most instructors have some experience working in health and/or educational settings and with older adults. Self-management education programs typically have two instructors per class, one of whom has arthritis or another chronic condition.

Are classes offered in languages other than English?

Spanish versions of the Arthritis Self-Management Program (Programa de Manejo Personal de la Artritis) and the Chronic Disease Self-Management Program (Tomando Control de su Salud) are available. Although they cover similar content, these programs are not simply translations of the English-language versions. They are culturally appropriate workshops developed and conducted in Spanish to address concerns specific to Spanish-speaking people with arthritis and other chronic health problems. The Arthritis Toolkit is also available in Spanish as Manejando Mi Artritis.

Is there scientific evidence supporting the use of these interventions?

Evidence from clinical trials and program evaluations demonstrates that people with chronic disease do benefit from participating in self-management education and physical activity interventions. CDC has evaluated a number of interventions based on a set of criteria that includes an adequate evidence base— specifically, these interventions have been studied for their effects on arthritis in a sample of at least 75 people and the findings have been published in a peer-reviewed scientific journal or other report. For detailed findings, point providers to the “What are the benefits?” and “Summary of the Evidence” sections of the provider intervention fact sheets. For some interventions, a separate evidence summary handout is available. References and links to individual journal articles are included in the fact sheets.

How can providers and their patients learn more about chronic disease self-management education and physical activity programs?

The outreach materials you leave behind in PCP offices summarize general information about self-management education and physical activity interventions, as well as specific information about each of the interventions you are promoting. The materials include Web sites with in-depth information about an intervention; the Interventions section of this website compiles information and links about all of the interventions. Make sure that providers have your contact information and encourage them to get in touch if they or their patients have additional questions.