2013 PATH Leader and Master Trainer Survey Findings

Michigan on the PATH Leader Survey, Michigan State University – College of Human Medicine 1

2013 PATH Leader and Master Trainer Survey Findings

August 31, 2013

About the Survey and Sample

In the Spring 2013, PATH leaders in the state of Michigan asked to complete an online survey.

In total, the survey yielded 156 responses, 125 of which completed all the questions.

About the Respondents

The majority of respondents held a license

from Office of Services to the Aging (34%),

followed by the Michigan Department of

Community Health (31%), the National

Kidney Foundations of Michigan (23%), and

Allegiance Health (9%).

PATH leader characteristics were analyzed

by the license the respondents held. For this

analysis and all further analyses by license

type, only licenses from the Michigan

Department of Community Health (MDCH),

the Office of Services to the Aging (OSA),

and the National Kidney Foundation of

Michigan (NKFM) were considered. Together, these comprised 88% of those who provided their

licensing type. MDCH leaders were somewhat more likely (82%) than OSA (68%) or NKFM

(63%) leaders to be living with a chronic

disease. Also, NKFM leaders were somewhat

more likely (33%) than OSA (17%) or MDCH

(13%) leaders to be a leader in a volunteer-

based community organization.

The survey asked for which PATH programs

the respondents had been trained and those

in which they had led a training in the past 12

months. For all of the PATH programs, a

significant proportion of the leader trainees

had not led a workshop yet. For respondents

who provided a reason for not having led a

workshop in the past 12 months, 13 said the

workshops are scheduled but then cancelled,

11 are newly trained leaders, 9 cited a lack of

workshop opportunities in their area, 4 replied


the workshops in their area don’t fit their schedules, and 1 is no longer able to be a PATH

leader. When asked what makes it difficult to lead PATH workshops, 62% replied “time

commitment with 40% stating “I need help marking the workshop.”

Most respondents (75%) became PATH leaders because it was part of their paid employment.

This is up from 59% of the respondents in 2011. Others heard about the opportunity to become

a PATH Leader from attending a PATH workshop (11%), having a healthcare provider

mentioning it to them (10%), or someone who talked to their community group (5%).

PATH leaders were asked to provide their year of

birth. The age range of the respondents is 22 years to

77 years. Status as a former PATH participant was

analyzed by respondent age group, among

respondents who answered both relevant questions.

Prior PATH participation was most common in

participants age 65-74 (33%) and least common in

participants age 18-34 and 75+ (both 0%, note only 3

respondents were age 75+).

Status as a current health professional was also

analyzed by respondent age group. Health

Professional status was very common in the 18-34

age group (85%), and diminished in each subsequent

age group; the 65-74 group had only 27% current

health professionals, and the 75+ age group (n=3)

had no health professionals.

Of the 106 respondents who provided their type of

position, 20 are nurses, 19 are health educators, 12

are administrators or staff at private practice or public

agencies, 10 are peer support specialists, 6 are in health promotion, 6 are outreach workers,

and 5 are social workers at a public or private agency.

PATH Leader Training Experience

Leaders self-identified their proficiency as a PATH

trainer: 35% were new, 36% were somewhat

experienced, and 29% were seasoned trainers. Only 18

of the respondents reported having been a PATH

workshop participant before being trained as a leader.

Almost a quarter (24%) of the respondents completed

their PATH leader training in 2011, 18% trained in 2012

and 15% were trained in 2013. On the other end of the

spectrum, 16% of the respondents were trained in 2010,


12% in 2009, 4% in 2008 and 11% in 2007 or before.

Half of the respondents said they were paired with an experienced leader for their first workshop

with 42% stating that they were not. Another 11% did not know about their co-leader’s

experience.

Aspects of the leader training experience were analyzed by the license the respondents held.

For this analysis and all further analyses by license type, only licenses from the Michigan

Department of Community Health (MDCH), the Office of Services to the Aging (OSA), and the

National Kidney Foundation of Michigan (NKFM) were considered. Together, these comprised

88% of those who provided their licensing type.

Substantially more respondents with NKFM licenses (70%) were paired with experienced

leaders during their first workshop than were either those with OSA licenses (47%) or MDCH

licenses (45%). Also, substantially fewer NKFM respondents (36%) heard about becoming a

PATH leader through their job than did MDCH (67%) or OSA (68%) respondents.

Since 33% of the respondents were trained in 2012

and 2013, it is not surprising that 18% had not yet co-

led a workshop and 14% have co-led one workshop.

At the other end of the experience level, 13% co-led

10 or more workshops. Of those in between, 31% co-

led 2-4 workshops and 23% co-led 5-9 workshops.

All of the respondents replied that the trainers did well

explaining that PATH is an evidence-based curriculum

based on the Stanford Chronic Disease Self-

Management Program and were aware of the past

research that had shown positive results for

participants who apply what their learn. Also, all

reported that the master trainers did well emphasizing

the importance of “sticking to the book” and not

adding, leaving out, paraphrasing, or otherwise

interpreting material from the curriculum, but instead

staying true to the script.

Thirty-nine of the respondents completed training on the revised PATH between July and

December of 2012. At the time of this survey, 64 of the respondents had completed the 2012

revised training from January through June of 2013.

PATH Marketing and Participant Recruitment

Respondents were asked about what would be useful in a new leader kit. Of the 121 PATH

leaders who replied, over 70 would like the following items to be included (number of

responders in parentheses):


1. PATH flyer (87)

2. Recruitment ideas (84)

3. PATH evaluation form (83)

4. PATH registration form (82)

5. PATH summary form (81)

6. PATH certificate (79)

7. Attendance sheet (75)

8. List of suggestions for resource table (73)

9. Timeline for setting up workshop (72)

10. MI PATH web address where you register workshops and get forms (72)

11. Healthy snacks list (70)

Recruitment of PATH Participants

Most PATH leaders (69%) were personally involved in the recruitment of workshop participants.

For those not involved in their own recruiting, clinic staff and senior center staff assisted with

this effort. Overwhelmingly, the top way to

recruit participants was word of mouth (92%).

Second best was with flyers (83%). Referrals

from community agencies (65%) and program

brochures (66%) were also used often. Other

types of recruitment were direct physical or

medical clinic referrals, health fairs, and

general announcements at community

centers. A few additional recruitment

techniques explained by PATH leaders

included sharing the DVD/program with

service clubs, sending personal letters of

invitation to potential participants, and making

personal contacts with physicians and

medical clinics to keep referrals flowing.

PATH leaders licensed under MDCH, OSA, or

NKFM were more involved with their own

recruiting when compared to leaders licensed

under a different organization. The

respondents licensed under the Office of

Services to the Aging had the highest

percentage of (76%) doing their own

recruiting with NKFM at 65% and MDCH at

60%. The leaders who did not do their own

recruiting reported that they most often relied

on their Community Service Organization

leader to do their recruiting.


The data demonstrated a positive correlation between the number of workshops led and

personal involvement in recruiting workshop participants. The ratio of leaders who reported

being personally involved in recruiting participants compared to those who are not increased as

the level of expertise became more advanced. It was also noted that as the number of

workshops that a respondent co-led increased, there was an increase in the number of

recruitment resources that were utilized. As a PATH Leader becomes more seasoned, he/she

tends to utilize referrals from medical clinics, direct physician referrals, flyers, and

sessions/announcements at community centers more commonly as forms of recruitment. With

the exception of the respondents 75 years of age and older, age did not appear to be a factor

when comparing the PATH leaders who recruited participants themselves compared to those

who did not do their own recruiting. With respect to the number of different recruitment methods

utilized, age did not appear to make a difference; all age groups averaged about six different

recruitment methods. However, it was found that the use of radio announcements and

newsletters as recruiting materials increased as the age group of the PATH leaders increased.

According to the data, healthcare professionals are more than twice as likely to conduct their

own recruitment than are non-healthcare professionals. Healthcare professionals are also twice

as likely to use patients from their practices as a method of recruiting, but are half as likely to

use newsletters in comparison to non-healthcare professionals. Aside from patients of their

practice and newsletters, there were no other significant differences between recruitment

methods utilized by healthcare professionals and non-healthcare professionals.

Sometimes workshops were cancelled due to low enrollment; 56% (n=59) of respondents had

cancelled or postponed a workshop. Only 20% (n=21) of leaders had to schedule additional

workshops because there was a waiting list of potential participants. Almost half of PATH

leaders (48%) have not noticed a difference in seasons that work best for recruiting. Of those

who cited a popular recruiting time, Spring and Fall were identified as the best seasons.

There were differences by license type of the reasons that make it difficult for respondents to

lead PATH workshops. A greater proportion of NKFM respondents (60%) than OSA (30%) or

MDCH (27%) respondents stated they need help marketing the workshops. In addition, a

greater proportion of NKFM respondents (33%) than MDCH (10%) or OSA (4%) respondents

stated that it is difficult to find suitable locations for workshops.

Preparing to Conduct a PATH Workshop

Most PATH leaders (44%) reported a one to two hour preparation time each week during a

PATH series. Twenty percent said it takes less than an hour and another 19% reported between

two to three hours. PATH leaders most commonly listed the following set-up activities: deciding

who would lead specific activities (98%), making sure the room is set up (96%), and making

sure sign up sheets are at each session (87%). Other set-up activities included making charts,

arranging snacks, and making sure forms were submitted to MDCH. At least 75% of

respondents performed each of these activities.


Contact with PATH Workshop Participants

Part of the PATH curriculum includes time for a co-Leader to call participants after the first

session; yet, only 63% of the leaders surveyed reported they always did so while 19% said they

do it most of the time. The remaining 19% said they call sometimes, not very often, or they

never call.

Part of the PATH leader responsibility is to

use the provided script with participants if

they drop out after the first week. Only 37% of

PATH leaders use the script always or most

of the time. Many PATH leaders (30%) also

reported they never use the script when a

participant drops out after week one.

Leaders were asked to list common reasons

their participants dropped out of PATH. Most

common responses included schedule

conflict (75%), no transportation (46%),

decline in health (42%), and that workshops

were not what the participant expected

(41%). Other reasons included not being able

to sit so long, feeling uncomfortable

discussing problems, interference with

caregiver duties, format too boring, and

difficulty hearing and/or seeing.

The PATH Leader Experience

Questions were asked about providing a Session Zero, having a resource table, using

handouts, and utilizing the buddy system during the PATH sessions. Only 13% stated that they

gave a Session Zero “always” or “most of the time”. Thirty-two percent stated that they gave a

Session Zero “sometimes” or “not very often,” whereas 56% “never” offered a Session Zero.

Thirteen percent of respondents listed a reason they did not always conduct a Session Zero.

Most common themes included not knowing what a Session Zero is and using a Session Zero

as a marketing technique to increase attendance or introduce PATH to a group of people.

Comments about Session Zero include:

When we do not have many people at the first session, we make it a zero.

When a group of people meets-like at a senior center-and we want to get people to

come with their friends.

When a group is getting together anyway and we can do a quick talk about it and get

them signed up.

If I don’t have 10 people signed up I offer a Session Zero.

If there is an existing group or site that is considering hosting a workshop.

We do for CDSMP but not for Chronic Pain or Diabetes.


NKFM respondents were more likely (33%) than OSA (14%) or MDCH (7%) respondents to

offer a Session Zero either always or most of the time. In addition, NKFM respondents were less

likely (22%) than OSA (59%) or MDCH respondents (70%) to never offer a Session Zero.

The majority of leaders stated that they always supply a resource table (51%). A quarter said it

depends either on location or on the types of participants, and 24% said they never provide

resource tables. The most common types of resources provided were information about specific

chronic conditions (74%), community event flyers (59%), local support group brochures (58%),

local human service brochures (42%), and healthcare power of attorney sample documents

(40%). Resources related to housing options and financial assistance were less common.

A smaller proportion of MDCH respondents (34%) than OSA (55%) or NKFM (65%)

respondents reported always using a resource table. In addition, a smaller proportion of NKFM

respondents (10%) than OSA (26%) or MDCH respondents (31%) reported using a resource

table depending on type of participant or location.

Over half of the leaders (54%) stated they provide handouts for participants. Among those who

do so, the most common handout is the action plan form (85%). Other handouts commonly

distributed include an advance directive/living will (43%), a self-management toolkit (25%), and

the symptom cycle (23%). In addition, 29% commented that they provide participants with class

schedule and/or homework schedule.

There is moderate use of the buddy system among PATH participants: 32% of respondents

stated their participants always used the buddy system, and 28% stated their participants used

this technique quite often. Only 7% stated their participants did not use the technique. Of those

who described why buddy system was used incompletely (n=8), the most common response

emphasized the buddy system as the responsibility of the participant. Several stated that their

participants were unwilling or unable to communicate with each other.

Many PATH leaders (63%) have worked with the same co-leader again after teaching more

than one workshop. Some chose to work together again and others said they work together as a

team. The other 37% wanted to work with the same co-leader again and would if it could have

been arranged.

Nearly 60% (n=55) of the PATH leaders have encountered a difficult participant in their PATH

sessions. Of these, 71% reported that the Leader training manual appendix on “situations for

dealing with difficult participants” was helpful when consulted. Another 9% consulted the

section, but did not find it helpful to solve their situation. Nearly 20% of leaders who

encountered a difficult participant did not consult the training manual appendix. Somewhat more

OSA respondents (68%) reported they had encountered difficult participants in any of the PATH

sessions where they had been a co-leader than did MDCH (53%) or NKFM (48%) respondents.

Only 66% of the PATH leaders are using the recommended self-evaluation form after

conducting the PATH workshop. Thirty leaders do not use this self-evaluation form even though


it is recommended during the leader training. Regardless of using the form, 86% of PATH

leaders prefer to talk with co-leaders after each session to discuss how the session went, and

another 11% have a discussion at the end of the workshop series. No co-leaders used the

assessment form provided. Another 3% never discussed how things went at PATH sessions.

How PATH Workshop Experiences are Influenced by Participant Type

More than half (55%) of PATH leaders agreed the type of participants in a workshop series

changes the way the material is covered during the 6-week sessions. Nearly all (92%) leaders

had observed the amount of discussion influenced by participant type (i.e., caregivers, patients,

type of chronic disease, literacy level). Other ways the workshop changed was the attention

span (58%) of participants, the number of difficult participants (46%), and that caregiver/patient

mixes (33%) changed the way PATH materials were covered in sessions.

More MDCH leaders (57%) than NKFM (36%) or OSA (30%) respondents indicated that the

type of participants in a PATH workshop changes the way the material is covered.

About 60% of the survey sample, representing 70 PATH leaders, shared a situation when the

PATH workshop experience was influenced by participant type. Comments related to this were

categorized into seven themes: literacy issues, elderly groups, quiet groups, chatty groups,

diverse groups, dominating individuals and self-interested individuals.

Literacy issues were an overarching challenge for the PATH workshops, influencing the pace

and structure of the 6-week series. Group characteristics were temperaments displayed by the

whole group, not just a few individuals, and were frequently cited as a result of the recruitment

strategy and location of the workshop. Finally, problematic individuals were also an influence on

PATH workshop fidelity, which was expected given this is also part of the PATH leader training

development. More examples of how the PATH workshop experience is influenced by

participant type follow in the brief definitions organized from PATH leader comments.

Literacy issues as well as income and socio-emotional status differences (including

educational level and occupational differences). “When participants have a lower

educational level more explanation overall is needed. They also tend to either discuss

far less, or question every single thing.” ”The more educated the participants are, the

faster you are able to cover the material.”

Frail, elderly groups take more class time (i.e., could not see charts, needed more

coaching in setting weekly goals).

Quiet groups without many discussions went quickly. “There have been classes, where

participants are more introverted and difficult to draw out.”

Chatty groups that already knew each other (e.g. church setting) had longer

discussions, but were highly compliant on homework like action plans.

Diverse groups mix the discussion (mostly caregivers, patients or influence of

professional and/or personal experiences). “The person who is a caregiver does not

seem to have as much in common with someone who is dealing with chronic illness.”

“Medically educated caregivers tend to run with discussions.”


Dominating individuals keep discussion off track (i.e., interruptive, aggressive, too

talkative). “When someone has an ‘aha’ moment and realizes they CAN take control of

their condition and they become ‘experts’ on what other people should do.”

Self-interested individuals steer conversations to topics of their interest. “Participant

had many physical issues and professional participant was ‘ranking’ the needs for her.”

“All were living with diabetes. Some were looking for diabetes-specific information.”

PATH Leader Comments

PATH leaders had an open-ended comment section where they could explain anything else

about their experience as a PATH Leader. Fourteen leaders wrote about the positive

experiences of serving as a PATH Leader such as interacting with the people and learning while

helping. A few shared concerns about being trained and wanting to lead a workshop, but had

challenges with low enrollment, recruitment in general, and living in rural places with small

populations. There were two comments about how participants’ questions are not always

covered by the scripts and how sticking to the book is insulting to a knowledgeable audience.

Finally, there was one comment that there is too much paperwork that comes with leading a

PATH series.

I love PATH and Diabetes PATH! I always meet wonderful people and always learn something new.

Difficult to maintain fidelity with certain populations

As an experienced wellness educator, I find the PATH program difficult to facilitate due to the many topics

covered in every session. No topic feels like it has been adequately developed. Also due to the time required

to read and prep, set up the workshop, lead the workshop and clean up, I personally am drained and tired

after the PATH sessions.

I feel very strongly that this is a worthwhile program. It is often difficult to get 6 week commitments from

individuals due to very busy lifestyles. I was recently diagnosed with a serious illness and was able to use

many of the techniques that I learned in training and shared in the workshop, These tools helped me to

handle a difficult diagnosis and treatment.

I think the changes in the updated program are very helpful.

This is a terrific program. I learn something about self-care every time I co-lead.

I would just like to reiterate that in rural areas it is difficult to get enough participants due to transportation

and other barriers.

Marketing the PATH Diabetes is much easier because the class is very specific. Regular PATH is much

broader and people have a difficult time understanding that one class could be useful for various diseases

and are less open to committing for 6 weeks. From what people have told me 6 weeks is a long time for

learning about high blood pressure when it is controlled by medication.

I love PATH and I wish I could do a workshop every day of the week. It’s great! I also have quit smoking for

over 6 months now and I believe much of my success has been because of what I teach in PATH.

PATH is the most effective health program that I have experienced or facilitated in many years of working in

health promotion. It motivates me to work on my own health issues and I work with others during a

workshop. I am never better as a self-manager as when I am doing a workshop. PATH can be life-changing

for participants,; my greatest challenge is convincing potential enrollees that they will benefit from PATH,

despite its perceived excessive length of 2 1/2 hours each week for six weeks. Things of quality may take

time, but so many people are not to embrace this axiom.

The addition of getting a good night’s sleep in the first week was a great idea. Everybody can benefit from

this lesson and everybody seems to get engaged on the in the discussion. This is the first brain storm

activity and sets a good precedence.


Master Trainers and T-Trainers Only

Several common techniques are used by Master Trainers in teaching new leaders to teach them

to “take off their professional hats” when co-leading a PATH workshop.

88% emphasize sticking to the book

85% make sure leader trainees understand their role as PATH leaders

65% talk about how PATH does not address specific clinical aspects of diseases and

conditions

62% emphasize the patient/caregiver empowerment aspects of PATH program

Others role-model the behavior during leader training, share examples from past groups, and

stress to new leaders to only show the professional hat before/after classes and on breaks. It

was nearly an even split (49% Yes/ 51% No) whether Master Trainers had seen leaders who

were not able to take off their professional hats. Of those that had experienced leaders acting

professionally rather than as empowerment agents, 67% (n=14) were able to address it directly

with the PATH leader in training. Yet, 29% (n=6) approached the trainee and still did not think

the trainee understood the difference in the role between PATH leaders and healthcare

professional.

About half of Master Trainers (n=18) have not had to counsel out a PATH leader in training.

Another 29% of Master Trainers have counseled out one potential leader because there was a

concern that they would not deliver the PATH program as it is intended. Seven Master Trainers

reported having to counsel out two to four different potential leaders in their time since training

new PATH leaders.

Only 59% of Master Trainers make resource tables available during the PATH leader trainings.

Those who do give out resources (41%) typically provide brochures to local human service

agencies/program, brochures provided by local health agencies, flyers for upcoming community

events, and community resource guides. Very few Master Trainers provide more information

about specific conditions or a list of state/national helpline numbers.

Most (47%) of the Master Trainers in this survey have been to four or more regional PATH

meetings. Just 17% (n=6) reported they have not attended a regional PATH meeting. A quarter

of the sample (n=9) had attended four or more trainings or leader updates held by the statewide

PATH team (Michigan on the PATH). Eleven Master Trainers have not attended any statewide

leader updates or PATH trainings.

Most Master Trainers (78%) had not observed any challenges to literacy skills of PATH leaders

that could have affected teaching the PATH material or facilitating discussions. Of the 22%

(n=8) who had observed literacy skill challenges most counseled the new leader out of doing a

workshop and sometimes the new leader self-selected to drop out after being trained as a

leader.


The comments from Master and T-Trainers made in the open-ended question were positive.

Comments were focused on being committed to the PATH program and enjoying the program

and being honored to be a part of the PATH program in Michigan.

Looking forward to getting more leaders trained in Chronic Pain and in PATH.

It is a privilege to work with the PATH program; it is a joy to present tools and skills to lay leaders and

community participants that make them great self-managers of their own health. A privilege, indeed.

A Note about License Type, Leader Proficiency, and Employment Status on Program

Fidelity

Analysis was conducted looking for significant patterns of association between three key

variables of interest: PATH License Type, Self-Described Proficiency as a Leader, and Paid

HealthCare Professional Status. Responses for all three subdivisions of the sample were

checked by (a) receiving a new leader kit when trained as a Leader, (b) being paired with an

experienced Leader when conducting first workshop, (c) whether in the past year, the Leader

had cancelled or postponed a workshop because of low enrollment, (d) whether in the past

year, the Leader had to schedule additional workshops because of a waiting list of potential

participants, and (e) the estimated amount of time spent each week in preparing for PATH

sessions.

2013 PATH Leader and Master Trainer Survey Findings

Documents