Better Choices, Better Health®
or Healthier Living With Ongoing Health Problems
(Internet Chronic Disease Self-Management Program)
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Better Choices, Better Health™, previously named Self-Management @ Stanford Healthier Living with Ongoing Health Problems, is an online workshop given on the Internet. Groups of about 25 people with a variety of ongoing health conditions participate together. Workshops are facilitated by two trained facilitators, one or both of whom are peers with a chronic health condition themselves. Topics covered include: 1) techniques to deal with problems such as frustration, fatigue, pain and isolation, 2) appropriate exercise for maintaining and improving strength, flexibility, and endurance, 3) appropriate use of medications, 4) communicating effectively with family, friends, and health professionals, 5) healthy eating, and, 6) making informed treatment decisions, 7) disease related problem solving, 8) advanced directives.
It is the process in which the online workshop is presented that makes it unique. Sessions are highly participative through internal messaging and online discussion boards, where mutual support and success builds the participants' confidence in their ability to manage their health and maintain active and fulfilling lives.
Each workshop is 6 weeks with new lessons each week. Participants are asked to log on at their convenience 2-3 times each week for a total of about 2 hours. There are no requirements that participants log in at the same time. The companion book for the workshop is Living a Healthy Life With Chronic Conditions, 4th Edition.
Does the Program replace existing programs and treatments?
The online workshop will not conflict with existing programs or treatment. It is designed to enhance regular treatment and disease-specific education such as Better Breathers, cardiac rehabilitation, or diabetes education. In addition, many people have more than one chronic condition. The program is especially helpful for these people, as it gives them the skills to coordinate all the things needed to manage their health, as well as to help them keep active in their lives.
How was the Program developed?
The workshop is the online version of the community-based Chronic Disease Self-Management Program (CDSMP), which was developed and evaluated during a five-year randomized, controlled research project completed in 1996. Development and evaluation of the online program was funded by the Robert Wood Johnson Foundation and the Archstone Foundation.
The process of both the online and community-based workshops are based on the experience of the investigators and others with self-efficacy, the confidence one has that he or she can master a new skill or affect one's own health. The content of the workshop was the result of focus groups with people with chronic health problems, in which the participants discussed which content areas were the most important to them.
How was the online program evaluated?
We recruited 958 adult study participants in 2002-2003. All participants had a diagnosis of heart disease (excluding uncomplicated hypertension), lung disease, or type 2 diabetes. Qualified participants were randomly assigned to either participate in the workshop or to a control group. Both groups completed 3 online questionnaires about their health status, health care utilization, self-efficacy and self-management behaviors over a 12-month period. The control group did not receive the workshop, but received a gift certificate after completing each questionnaire and the book used in the workshop* at the end of the 12-month period.
What were the results?
At 1 year, the group who took the online workshop had significant improvements in health statuses compared with the control group. The intervention group had similar results to the small-group CDSMP participants. Change in self-efficacy at 6 months was found to be associated with better health status outcomes at 1 year.
Is the program being offered?
The National Council on Aging (NCOA) has licensed the Better Choices, Better Health® program. See the NCOA website for more information. If you are a participant and would like to take part in a workshop, please email betterchoices@selfmanage.org.
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