1 n This product was by Research Triangle Institute International, External Evaluation Team of the Robert Wood Johnson Foundation Diabetes Initiative. Support for this product was provided by a grant from the Robert Wood Johnson Foundation® in Princeton, New Jersey.
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1
n This product was by Research Triangle Institute International, External Evaluation Team of the Robert Wood Johnson Foundation Diabetes Initiative. Support for this product was provided by a grant from the Robert Wood Johnson Foundation® in Princeton, New Jersey.
Measuring Resources and Support (RSSM) for
SelfManagement of Diabetes Lauren McCormack, PhD, MSPH; Joe Burton, MS; Carla Bann, PhD;
Pam WilliamsPiehota, PhD; Claudia Squire, MS; Doug Kamerow, MD, MPH; Ed Fisher, PhD; Russ Glasgow, PhD
Presented at the Society of Behavioral Medicine Conference, March 2006 Funded by the Robert Wood Johnson Foundation
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Outline for the Presentation
n Overview of the Diabetes Initiative evaluation
n Development of the RSSM instrument
n Findings l Scores on RSSM scales l Relationship between RSSM and health behaviors
n Implications for future research
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RTI’s Evaluation of the Diabetes Initiative
n Site Visits—inperson visits to 14 sites
n Longitudinal crosssite survey l Program participation, RSSM, health behaviors (smoking, diet and nutrition, physical activity, medical management), other measures
n Examination of enrollment and clinical data l Enrollment/disenrollment l Clinical measures (HbA1c, blood pressure, cholesterol)
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Chronic Care Model
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Development of the RSSM Instrument
n Maintained an ecological perspective and chronic care focus
n Reviewed existing instruments
n Tailored existing items, drafted new items
n Conducted two rounds of cognitive testing
n Gained input from NPO, RWJF, Advisory Panel
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Patient Assessment of Chronic Illness Care (PACIC)
n 26item survey that provides a patient perspective on receipt of CCMrelated chronic illness care
n PACIC subscales: l Patient activation l Delivery system/practice design l Goal setting/tailoring l Problem solving/contextual l Followup/coordination
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RSSM Subscales
n Collaborative goal setting
n Individualized assessment
n Quality of care/communication
n Learning skills
n Followup and support
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CrossSite Surveys
n Wave 1 (Winter/Spring 2005) l N = 720 completes l Response rate = 70%
n Wave 2 (Winter 2006) l N = 957 of which ~1/2 were also in Wave 1
l Response rate = 68%
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Sample Characteristics: Wave 1
n Mean age = 56 years
n 70% female
n 54% were of Hispanic, Latino, or Spanish origin
n 45% of the sample had less than a high school education
n 49% reported their health status as fair or poor
n Mean of 10 years with diabetes
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Psychometric Properties of RSSM Scale
n Mean RSSM score = 3.95 (SD = 0.85)
n Overall alpha = 0.90
n Confirmatory factor analysis—5 factors l Scale correlations ranged from 0.42–0.74
n Alphas for subscales ranged from 0.70 to 0.84
n Subscales correlated with Hibbard’s Patient Activation scale (subset of items)
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Relationship Between RSSM and Patient/Program Characteristics
Program Type
3.85 3.82
4.43
3.47 3.68 4.01** 3.70***
4.59* 4.11***
3.88
0.00
1.00
2.00
3.00
4.00
5.00
FollowUp and Support
Collaborative Goal Setting
Quality of Care Individualized Assessment
Skills
ADSM BCS
*p < .05, **p < .01, ***p < .001
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Results: Collaborative Goal Setting
42
69
89
92
0 20 40 60 80 100
Contact you between appointments
Check to see how you were doing with goals
Helped you make a plan
Set goals
Percentage Yes/Usually or Always
Contact you between appointments
Set goals
Check to see how you were doing with goals
Helped you make a plan
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Results: Individualized Assessment
46
70
71
0 20 40 60 80 100
Ask about your cultural traditions
Ask about what is important to you
Ask you questions about your health habits
Percentage Yes/Usually or Always
Ask about your cultural traditions
Ask about what is important to you
Ask you questions about your health habits
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Results: Quality of Care/Communication
84
90
0 20 40 60 80 100
Explain things so you could easily understand
Someone on your DCT listens to you carefully
Percentage Yes/Usually or Always
Someone on your DCT listened to you carefully
Explained things so you could easily understand
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Results: Learning Skills
57
70
82
0 20 40 60 80 100
Teach you how to deal with stress/feeling sad
Teach you how to deal with problems
Teach you how to take care of your diabetes
Percentage Yes/Usually or Always
Teach you how to deal with problems
Teach you how to deal with stress/feeling sad
Teach you how to take care of your diabetes
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Results: FollowUp and Support
34
63
68
75
77
84
0 20 40 60 80 100
Talk/meet someone on your diabetes care team
Ask about problems with medications
Help you find support groups
Get the information that you needed from your DCT
Help you get medicines and other supplies
Schedule appointments
Percentage Yes/Usually or Always
Get the information that you needed from your DCT
Help you get medicines and other supplies
Talk/meet someone on your diabetes care team
Help you find support groups
Ask about problems with medications
Schedule appointments
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Path Diagram of RSSM as a Mediator of the Relationship between Patient and Program
Characteristics and DiabetesRelated Behaviors
Predictor Variables RSSM
FollowUp and Support
Collaborative Goal Setting
Communication
Individualized Assessment
Skills
Diet and Nutrition
Program Participation
Physical Activity
0.17*
0.22*
0.51*
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Model Results
n The following groups reported significantly higher RSSM scores: l Hispanic origin l Having a personal doctor l “A lot” of selfreported knowledge of diabetes (vs. “nothing/a little”)
l More frequently talking to someone about feelings about having diabetes
l Higher patient activation l Higher fatalism l Never (vs. rarely) have difficulty understanding diabetes information
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Model results (cont.)
n The following groups reported significantly lower RSSM scores: l Older age l Other race (vs. white) l Income of $30,000$49,999 (vs. <$10,000)
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Conclusions
n A promising new instrument with good psychometric properties
n Potential for broader application to other chronic diseases
n Could be tailored to primary care issues
n Consider expanding instrument to include other domains
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Next Steps for Analysis
n Finalize wave 1 results
n Analyze wave 2 data
n Analyses using wave 1 and wave 2 cohort
n Merge on clinical data
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