Bright Spot: Diabetes Self-Management Program (DSMP)

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This bright spot was originally published in the 100 Million Healthier Lives Change Library and is brought to you through partnership with 100 Million Healthier Lives and the Institute for Healthcare Improvement.

Overview

Detailed Description

The Diabetes Self-Management Workshop is given 2 1/2 hours once a week for six weeks in community settings such as churches, community centers, libraries and hospitals. The workshops are attended by people who have type 2 diabetes in groups of 12-16 and are facilitated by two trained leaders, one or both of whom are peer leaders with diabetes themselves. The program relies heavily on participation, and mutual support and success build the participants' confidence in their ability to manage their health while also maintaining active and fulfilling lives.

Subjects covered in the workshops include:

Techniques to deal with symptoms of diabetes, fatigue, pain, hyper/hypoglycemia, stress, and emotional problems such as depression, anger, fear and frustration
Appropriate exercise for maintaining and improving strength and endurance
Healthy eating
Appropriate use of medication
Working more effectively with health care providers
Participants also make weekly action plans, share experiences, and help each other solve problems encountered when creating and carrying out their self-management program.

Expected Outcomes

The overall goal is to enable participants to build self-confidence to take part in maintaining their health and managing their diabetes. The desired outcomes are: Increase in healthy behaviors (i.e., exercise and cognitive symptom management techniques, such as relaxation), positive changes in health status (less pain, fatigue, and worry; less health distress), increased self-efficacy, better communications with health providers, and fewer visits to physicians and emergency rooms.

Cost Details

As of May 2014, the cost of this intervention is as follows:

Costs for group training at Stanford for the 4.5 day CDSMP Master Training $1700 per health professional, $1,000 for a lay person with chronic disease, $0-$200 for lay leader training
Costs for web-based cross-trainings are: $450.00 for Diabetes Self-Management Program Web-based update training
Costs for update trainings are: $250.00 Off-Site Training by Stanford University, $10,000 paid to Stanford (Training fee), $6,000 paid directly to 2 T-Trainers ($3,000 each)
Cost for 2-day cross-training (English Diabetes, Chronic Pain, Tomando, or Spanish Diabetes): $4,000 paid to Stanford (Training Fee) and $2,400 paid directly to 2 trainers ($1, 200 each)
Cost for 1 day cross-training (Positive Self-Management): $2,000 paid to Stanford (Training fee) and $1,200 paid directly to 2 trainers ($600 each)

Additional costs for off-site training:

The organization contracting for the training will need to supply: Transportation, lodging, and per diem for two trainers
Materials for all trainees. These include one book for each program, two manuals for each program, and a relaxation CD. All but the manuals can be purchased directly from Bull Publishing. Stanford will send the master copies for the manuals to the organization hosting the training for reproduction. Costs for books and CDs can be found on Bull Publishing's website
One full set of complete workshop charts for each program, (Optional) One copy of the CDSMP provider video (for CDSMP training), available from Bull Publishing.Training in Spanish for chronic disease has one additional exercise CD, available from Bull Publishing.
Single-program license fees: If your organization wishes to offer only one Stanford Program in one language: $500.00 for offering 30 or fewer workshops and 2 Leader trainings $1000 for offering 70 or fewer workshops and 3 Leader trainings and $1500 for offering 110 or fewer workshops and 5 leader trainings.
Multiple-program license fees: If your organization wishes to offer more than one Stanford Self-Management Program (for example, CDSMP and Tomando, or CDSMP and Diabetes, etc., and you have Leaders trained for each Program): $1,000.00 for offering up to 65 total (all programs combined) workshops and 4 Leaders trainings, $1,500.00 for offering up to 100 total (all programs combined) workshops and 6 Leaders trainings.

For the latest cost details, please contact the Diabetes Self-Management Program directly.

Key Steps for Implementation

Trainings for representatives of health care organizations are 4 1/2 days.

Web-based cross-training is also offered for those who have already been trained to offer the Chronic Disease Self-Management Program.

See the Training for Self-Management Programs page for details. A list of licensed organizations in North Carolina is available here.

Interested Individual/families in North Carolina should reach out to the regional Area Agency on Aging first to see what programs are offered, discuss how the program can be expanded to a new site/location, and then identify the steps necessary (securing a license, training leaders, or offering referrals).

Other Key Requirements

Any organization giving a Stanford program must purchase a license. Schedule of training and licensing fees can be found on the fees page.

Required Staffing (FTEs)

Depending on the number of workshops|the program coordinator position can be anything from a 25% time position to a full-time position. Also every organization does not need Master Trainers. If the plan is to train lay leaders less than twice a year|then it is advised to work with a nearby organization and train leaders together to cut costs. Lay leaders are usually volunteers but it is suggested that they receive a small stipend. A list of licensed organizations in North Carolina is available here.

Special Infrastructure

Program sites must meet several minimal criteria. They must be: Handicap accessible (this includes not requiring the use of stairs), safe, be able to accommodate up to 20 people in a circle or U, have parking if this is a consideration, be near public transportation if this is a consideration, have well lighted exteriors if the program is after dark, be open to having anyone from the community attend, have a room that provides privacy and provides enough space for the leaders, participants, flip charts, white board and still moving around, have insurance. The site should also be in the same community you want to serve so that in most cases participants will need to travel a very few miles or sometimes blocks to reach the site.

Training

It is strongly suggested that health professionals bring a lay person with chronic disease with them to the trainings. All workshops and trainings are designed to be facilitated by 2 people, therefore it is important that new organizations send 2 people to the training, or they will be unable to implement the program

On-site training for the Chronic Disease Self-Management Program is offered at Stanford. Two Stanford trainers will train up to 24 Leaders and/or Master Trainers at your facility

Due to demand for these trainings, it is necessary to plan 4-6 months in advance

For more information about the trainings, registration, and fee schedules, see the Training for Self-Management Programs page.

Types of Staff

Instructors must be health professionals, or lay leaders/caregivers or with a chronic health problem. Instructors must be able to complete the DSMP training. It is suggested that at least one leader be a non-health professional.

Return on Investment Details

Local health departments, Local hospitals, Faith-based organizations, Senior centers community agencies

Evaluation Strategies and Data Collection Tools

Intervention-specific resources: Eating Breakfast with Protein
Glucose Testing
Medication Taking
Diabetes Self-Efficacy
Hyperglycemia (Diabetes)
Hypoglycemia (Diabetes)
Chronic Disease Research Instruments

Outcome Measures

Health status (disability, social/role limitations, pain and physical discomfort, energy/fatigue, shortness of breath, psychological well-being/distress, depression, health distress, self-rated general health)
Health care utilization (visits to physicians, visits to emergency department, hospital stays, and nights in hospital), self-efficacy (confidence to perform self-management behaviors, confidence to manage disease in general, confidence to achieve outcomes)
Self-management behaviors (exercise, cognitive symptom management, mental stress management/relaxation, use of community resources, and communication with physician)

Process Measures

Number of trainings attended by health care professionals and/or lay persons
Number of workshop participants