Evaluation of a rural chronic disease self-management program

INTRODUCTION

Internationally, the prevalence of long-term health conditions is at epidemic proportions. Australia is no exception. The Australian Government's 'Better Health Initiative' has 5 key strategies to build better health care, one of which is the adoption of self-management and self-management support. Self-management allows people to manage their condition and the consequences it brings to their lives in partnership with their health providers. The purpose of this article was to report both the process and patient outcomes following the introduction of the Stanford Chronic Disease Self-Management Program (CDSMP) into an existing service in an Australian rural setting.

METHODS

Implementation processes were evaluated using semi-structured interviews conducted with managers, lay and health professional course leaders and participants about positive and negative aspects of providing the CDSMP. Participant outcomes were evaluated using a modified pre-test, post-test design to evaluate changes in activity participation and self-management knowledge and skills.

RESULTS

Both negative and positive aspects of providing the program were represented by two key themes: (1) program content and quality; and (2) logistics of delivery. Throughout the interviews, managers and leaders, and course participants offered recommendations that were thematically grouped into 3 categories: (1) enhancing quality; (2) improving the logistics; and (3) providing resources. Comparison of activity levels with a community sample indicated that participants had significantly decreased participation levels. Scores on the Health Education Impact Questionnaire v2 (heiQ - RETRO) demonstrated statistically better scores at post-test on the domains of 'self monitoring', 'insight' and 'health service navigation' with a trend towards significance on 3 other domains.

CONCLUSIONS

Future implementation of CDSMPs in rural areas will be encouraged by these patient outcomes, and informed by the qualitative findings from managers, leaders and course participants.

Polyamines permit the preparation of stable Physarum core particles which have a structure similar to those from higher eukaryotes

The inherent instability of Physarum nucleosome core particles prepared by micrococcal nuclease digestion in Na+/Ca2+ buffers can be overcome by the addition of 0.15 mM spermine and 0.5 mM spermidine. Neutron scattering, circular dichroism, nuclease digestion and thermal denaturation studies carried out on these stable monosomes show them to be very similar to those obtained from higher eukaryotes.

A further assessment of the sub-nucleosomal product, "peak A", from Physarum polycephalum

Nuclease digestion studies of Physarum polycephalum nuclei (1-3) and nucleoli (4) over the past few years have been centred on a number of modified nucleosomal products which have been related to active-gene regions of the genome. We have re-investigated one such particle, peak A, using the techniques of differential melting and polyacrylamide gel electrophoresis and show that this material is unlikely to be a specific histone:DNA complex as suggested by earlier authors.