Chernett, Nancy L.

Gitlin, Laura N.

Name not available

Harvest Health:  Chronic Disease Self-Management Program for Older African-Americans

Jefferson Digital Commons

Health Policy Newsletter____________________________________________________________ Volume 18 Number 3    September, 2005               Article 9 ____________________________________________________________  Harvest Health:Chronic Disease Self-Management Program for Older African-Americans  Nancy L. Chernett, MA, MPH* Laura N. Gitlin, PhD*   *Thomas Jefferson UniversityCopyright ©2005.  Health Policy Newsletter is a quarterly publication of TJU, JMC and the Department of Health Policy, 1015 Walnut Street, Suite 115, Philadelphia, PA  19107.Suggested Citation:Chernett NL, Gitlin LN.  Harvest Health:  Chronic disease self-management program for older African-Americans.  Health Policy Newsletter 2005; 18(3):  Article 9.  Retrieved [date] from http://jdc.jefferson.edu/hpn/vol18/iss3/9.Nancy L. Chernett and Laura N. Gitlin:  Harvest HealthHealth Policy Newsletter Vol. 18, Number 3 (September 2005), Article 9Harvest Health: Chronic Disease Self-Management Program for Older African-Americans  Chronic health conditions are the major causes of illness, disability and death in the United States, with African Americans bearing a greater burden compared to Whites. In Philadelphia, this disparity is particularly evident. According to research conducted by the Philadelphia Health Management Corporation (PHMC) in 2004, older African Americans in Philadelphia were more likely than Whites to rate their health as fair or poor (47.5% versus 34.1%); have a chronic health condition (43.4% versus 38.6%); have diabetes (30.5% versus 13.1%) and high blood pressure (71% versus 51.6%).1While recent research shows that with appropriate training and support, persons with chronic disease can learn to effectively manage their own diseases, few studies have focused on what works best with underserved populations.2,3 One successful program, the Chronic Disease Self-Management Program (CDSMP), a patient education program developed by Dr. Kate Lorig at the Stanford Patient Education Research Center, has been found to improve health status and self-efficacy, and reduce healthcare utilization in White, middle income elders using randomized trials.4 Philadelphia’s Harvest Health project is one of 13, three-year projects funded in 2003 by the U.S. Administration on Aging Evidence-based Disease Prevention Program.5 Harvest Health aims to extend the CDSMP to an urban, African American, older adult population through a collaborative efforts of four organizations: 1) The Philadelphia Corporation for Aging, functioning as the project administrators; 2) Center in the Park, an urban senior center, responsible for recruiting participants and implementing the CDSMP with 500 African American older adults; 3) Albert Einstein Healthcare Network (AEHN), a healthcare organization, charged with educating and seeking referrals from primary physicians; and 4) The Center for Applied Research on Aging and Health (CARAH) at Thomas Jefferson University, which is evaluating both the program’s effectiveness and the collaborative process.   The CDSMP, a 6-week, 15-hour, peer-led education program is based on the premise that people with different chronic conditions present common issues and needs—dealing with symptoms, complex medication regimens, behavioral lifestyle adjustments and obtaining helpful medical care. The program is designed to empower patients to assume an active role in their health by managing symptoms. The mechanisms that underlie the program’s effectiveness include: 1) participant development of weekly action plans based on individualized goals, 2) instruction in multiple approaches to symptom management, and 3) group dynamics that provide opportunities for problem solving, peer modeling, and social persuasion.   A key issue in translating evidence-based programs to community groups is balancing intervention fidelity (i.e. is the program being delivered as it is intended) with program modifications deemed necessary to ensure acceptance by the target population and community.6,7 Harvest Health replicates the essential elements of CDSMP, but also implements cultural modifications to maximize the program’s acceptability. One important adaptation was the name choice, “Harvest Health”. Developed by Center in the Park, the partners endorsed this name based upon the historical and biblical associations many African Americans have with the word “harvest”. The program’s name is a welcoming and warm, nonmedical symbol Nancy L. Chernett and Laura N. Gitlin:  Harvest HealthHealth Policy Newsletter Vol. 18, Number 3 (September 2005), Article 9signifying the concept that one reaps what one sows (e.g., taking care of yourself results in an abundance of health).   As of July 1, 2005, 322 persons (mean age of 72 years, 78 percent female) have participated in Harvest Health, with a retention rate of 87 percent (those attending at least 4 of 6 weekly classes). Preliminary results indicate a high level of satisfaction among participants. Through a pre- and post-intervention evaluation design, Year One outcomes for the 94 participants who completed both a baseline and a 4-month follow-up questionnaire indicate significant increases in stretching and strengthening activities (p=.000), a trend towards increases in aerobic physical activity (p=.076), and a significant reduction in health distress (p=.000). At 4 months, 95 percent reported continued use of strategies to increase physical activity, improve their diet, and increase symptom management.   The project’s collaborative process evaluation includes both quantitative and qualitative measures using periodic surveys and structured interviews of each team member to identify the mechanisms by which the partnering organizations can work together more successfully, as well as barriers that may impede effective teamwork. Key factors for trust-building and cohesive partnerships have been the establishment and refinement of systems for ongoing communication, providing strong project leadership, and creating a safe environment to voice opinions. These data highlight the importance of each organization’s having an ongoing commitment to the project goals, and developing processes for continually assessing and negotiating each partner’s role.   The Harvest Health project thus far demonstrates the utility of the CDSMP patient self-management program with a traditionally underserved population, African American older adults. It also shows the value and importance of partnerships to ensure the success of translating and implementing evidence-based programs to enhance the health of a targeted community. This collaborative approach, linking community service organizations with healthcare organizations, is an important, replicable model that can be used in the implementation of additional evidence-based programs (e.g., fall prevention) with other target populations.   References  1. Southeastern Pennsylvania Household Health Survey, 2004 Philadelphia Health Management Corporation's Community Health Database.   2. Frank JC. Review of literature on self-management of chronic illness and behavior change. 2002. Prepared for The National Council on Aging Model Programs Project.   3. Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self-management approaches for people with chronic conditions: a review. Patient Educ Couns.2002;48(2):177-187.   4. Lorig KR, Sobel DS, Stewart, AL, et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Medical Care. 1999;37(1):5-14.   Nancy L. Chernett and Laura N. Gitlin:  Harvest HealthHealth Policy Newsletter Vol. 18, Number 3 (September 2005), Article 95. Administration on Aging, Evidence-based Disease Prevention Grants Program. Available at: www.aoa.gov/prof/evidence/evidence.asp. Accessed on June 1, 2005.   6. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Affairs.2001;20(6):64-78.  7. Glasgow RE, Kleges LM, Dzewaltowski DA, Bull SS, Estabrooks P. The future of health behavior change research: what is needed to improve translation of research into health promotion practice? Ann Behav Med. 2004:27(1):3-12.    About the Authors  Nancy L. Chernett, MA, MPH, is a Project Manager and Laura N. Gitlin, PHD, is Director of the Center for Applied Research on Aging and Health at Thomas Jefferson University.  The Center is a participant in the Harvest Health Partnership with the Philadelphia Corporation for Aging, Center in the Park, and Albert Einstein  Healthcare Network.   

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Harvest Health: Chronic Disease Self-Management Program for Older African-Americans

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