Group processes and therapeutic factors in chronic disease self-management program

Abstract

This study investigates the group process and therapeutic factors of the Chronic Disease Self-Management Program (CDSMP). The CDSMP is a community-based program for persons with chronic diseases that aims to assist people to enhance their self-efficacy and self-management behaviors. The CDSMP is led by patient or professional leaders. It utilizes different self-efficacy strategies in the group process such as modeling, action planning, social persuasion and evaluation. A number of studies have focused on the positive individual outcomes for members in the CDSMP, but there have been few studies on how group processes impact self-management outcomes. This study aims to evaluate the group process of the CDSMP using a group dynamics perspective - the Therapeutic Factors (Yalom, 1985), and examines the relationships between group therapeutic factors and members' individual outcomes. First, a validation study was conducted to develop an instrument for measuring group processes - the Group Therapeutic Factors Questionnaire (GTFQ). Its content validity was examined by an expert panel. The reliability and the internal consistency of the GTFQ were evaluated based on a sample of 30 persons with chronic illness. The 38-item GTFQ was also administered to 202 participants in the CDSMP, providing data for evaluating the factor structure. Results showed that the GTFQ has good content validity, a stable factor structure, and that this instrument is reliable over time. Second, the main study was conducted to evaluate the therapeutic factors and the group process of the CDSMP, using a combination of quantitative and qualitative methods. In the quantitative analysis, 41 participants completed the GTFQ and the standard outcome measures of the CDSMP. In the qualitative analysis, the group content of three sessions of the CDSMP (Sessions 2,4, and 6 out of six sessions) was recorded and transcribed for the content analysis. The results of the quantitative analysis showed that "instillation of hope," "existential factors," and "universality" were perceived as the most important therapeutic factors in the CDSMP. Consistent with the results of the content analysis, "universality" and "instillation of hope" were the major group therapeutic factors in the CDSMP. These results indicated that members developed optimism through observing members' improvement during the six-week group process. They realized that members were coping with similar barriers with regard to health problems. Also, only a few of the therapeutic factors correlated significantly with the individual outcomes of members in the CDSMP. The content analysis further showed that "guidance" was frequently used during the group process, which indicates that the CDSMP is designed to deliver comprehensive patient education content on illness management. "Catharsis" was observed to be another core factor leading to the positive outcomes. The members became more willing to disclose their feelings, and started to discuss personal issues in the latter sessions of the CDSMP. A mature group atmosphere was observed in the Jast session. To summarize, the results of this study indicate a successful group outcome of the CDSMP. The group process in the CDSMP is essential to facilitate members' personal change, and to increase their self-efficacy in managing their illness.