History of the Chronic Disease Self-Management Program in West Virginia

In 2003, through funding from the Robert Wood Johnson Foundation (RWJF) Diabetes Initiative,  the Marshall Center for Rural Health became licensed to provide training and support for the Chronic Disease Self-Management Program developed by Stanford University. The Stanford University Chronic Disease (CDSMP) and Diabetes (DSMP) Self-Management Programs have been conducted in West Virginia for the past 13 years through the leadership of staff from the Center for Rural Health at Marshall University.

With the initial RWJF funding, Marshall  developed a network of rural partnerships that worked  together to improve the health and health care for people with diabetes and other chronic conditions. Partners include the Appalachian Regional Commission diabetes coalitions, the Partnership of African American Churches congregational communities, the United Mine Workers Health and Retirement Fund, West Virginia Health Care Improvement Initiative, and federally qualified primary care centers.

The Marshall outreach team provide training, technical assistance and support to expand organizational capacity to disseminate CDSMP workshops in partner communities across West Virginia.

In March 2010, national implementation of CDSMP and DSMP was begun by state public health departments, with funding from the American Recovery and Reinvestment Act, and oversight from the National Council on Aging and the Administration on Aging.  The Division of Health Promotion and Chronic Disease at the West Virginia Bureau for Public Health was funded under this initiative in partnership with Marshall University (implementation partner), West Virginia University (evaluation partner), and several other state agencies to disseminate CDSMP state-wide.

During the 2 year period of the ARRA funded initiative the state’s 2 T-Trainers, Sally Hurst and Richard Crespo held 18 training workshops and trained 98 CDSMP leaders, 86 DSMP leaders, and 37 master trainers.  Six hundred fifty-seven people attended, and 506 completed (attended at least 4 of 6 workshop sessions), the 64 workshops (48 CDSMP, 16 DSMP) that were offered by 57 leaders in 17 counties at 40 sites in West Virginia. 

In addition to collecting demographic and chronic health condition data as required by the grant, collection of participant outcomes data began in January 2012. Data are being collected on self-rated health, symptoms (pain, fatigue, shortness of breath), self-efficacy, social/role activity limitations, healthcare communications, healthcare utilization, exercise/physical activity, and health-related quality of life.  To date, baseline, 3-month, and 6-month data have been collected from 167, 56, and 37 participants, respectively. 

The data collected thus far indicate that the Programs are reaching those with the greatest need (i.e., worst health).  National statistics rank West Virginia as second highest in the country for arthritis prevalence(34%), and second for diabetes (12%).1, 2  The health profile of the workshop participants has been consistent with these rankings, where arthritis is the most frequently reported chronic health condition in 46% of attendees, and diabetes is third in 37% of participants.  In all cases, prevalence rates of specific chronic health conditions in West Virginia participants meet or exceed those of the state and US general population.  Although data collection is ongoing, participants have reported a significant reduction in physician visits (3.9 versus 1.7, p = 0.002) and an improvement in healthcare communications score (2.8 versus 3.1, p = 0.004) between baseline and three months.

This project was a collaborative effort among many community, state, and academic partners in West Virginia and was successful in reaching more than the targeted 500 people with the CDSMP/DSMP.  However,  as the grant ended, many of the partners who were committed to continuing their efforts to lead workshops in West Virginia discontinued workshop outreach as infrastructure support from the WV BPH ended. 

WV now has another funding opportunity to re-establish regional support for the dissemination of self management workshops through funding from a Community Transformation Grant and Change the Future WV efforts.  Thus far in 2013,  Marshall T-Trainers have conducted two Master  Trainings  for Change the Future community coordinators and is working closely with local health department leaders to  support the development of a regional infrastructure  for sustaining self-management programs through local health departments and Change the Future efforts. 

Reference List

  (1)   West Virginia Bureau for Public Health, Office of Community Health Systems and Health Promotion. Advocating for Chronic Disease Management and Prevention 2011. Charleston, WV: West Virginia Department of Health and Human Resources; 2011 May.

  (2)   Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey Data. Office of Surveillance, Epidemiology, and Laboratory Services 2009.