Factors Influencing Possible Participation in Chronic Disease Self-management Courses

Abstract

Chronic disease self-management (CDSM) courses have been shown to be effective in improving self-management, quality of life and clinical outcomes; however, participation rates in both generic and disease-specific courses are low. The objective of this qualitative study was to explore the attitudes, perceived behavioural control (PBC) and subjective norms of general practice patients with chronic diseases towards future participation in a CDSM course. The study, conducted in 2 006, used semi-structured interviews with a purposive sample of eight men and 11 women who had a chronic disease. The theory of planned behaviour provided a framework for a thematic analysis of the data identifying themes related to attitude, PBC and subjective norms. Nine themes were identified related to attitude. These included a desire for the opportunity to share/gain support; willingness to participate if they were provided with more/new information; basing their choice on severity of disease; trying the program out first; individual coping strategies; reliance on medical practitioner advice; needing some certainty or being afraid of future prospects; doing things in their own particular way; and deciding on the basis of proven results. Six themes emerged related to PBC, which revolved around structural barriers, time, transport, cost, mobility, convenient time and location. Three subjective norms were identified including encouragement from family/friends, medical practitioner and others with the same condition. Several positive attitudes such as the provision of information, opportunities to share and gain support and help with coping - which CDSM courses offer - could be capitalised on when promoting the courses. However, understanding other attitudes such as the importance of disease severity and a need to 'do it my way', reveal misconceptions about the aims of CDSM courses that need to be more clearly communicated when promoting courses. Structural barriers to participating in CDSM courses can easily be overcome by careful planning and adequate funding. Finally, general practitioner encouragement to attend CDSM courses could improve participation rates.