Primary Health Care System
RESEARCH AND KNOWLEDGE TRANSFER

SEED FUNDING REPORTS

Gender-specific approaches to self-management of chronic disease?
Principal investigator/co-investigators:
Julie Richardson is a Professor in the School of Rehabilitation Science at McMaster University.
Lori Letts is Associate Professor in the School of Rehabilitation Science and Assistant Dean of the Occupational Therapy Program at McMaster University.

Background:
The planning and delivery of health services at national, regional and local levels need to consider gender equity. Purpose: To examine how gender influences engagement in SM programs in primary care and how this affects functional health.

Methods:
Three approaches were used to explore gender issues and SM in primary care:

• An environmental scan and content analysis of published literature related to SM initiatives or programs designed to address gender differences in SM.
• Qualitative interviews with CDSMP participants to explore their perceptions about how their gender may have influenced their engagement in SM.
• A secondary subgroup analysis, ( age x gender) from a primary care clinical trial that examined the effect of rehabilitation to optimize functional outcomes in persons with chronic disease, using SM approaches.

Results:
Findings from our qualitative study suggest gender differences related to CDSMP included: 1. Content preferences and course structure; 2. Accessing CDSMP, participation, completion/attrition and variations in outcomes. The secondary data analysis revealed gender differences in function (physical, social and personal) and hospital utilization but no differences in SM and self-efficacy scores. Women report higher functioning which may be due to more effective engagement in SM.

Conclusion:
Men and women access, engage and actively participate in CDSMP differently. Increased physical activity is a prevalent goal in CDSMP for men and women. Flexible strategies in delivering CDSMP are required, using group, individual and distance opportunities. The interactions with the healthcare team members need to reinforce and support patients’ efforts in SM.

Key Messages:
Through this exploratory study we have identified key issues in the area of gender and chronic disease self-management.  The literature review reveals gender as potentially significant to three key areas in self-management interventions. 

• First, our findings suggest that there may be gender differences in the content and delivery of self-management interventions.  These variations may be reflected in preferences to address different substantive themes in CDSMPs (e.g., pain management for men versus information about exercise for women) and the modes of delivery (e.g., group versus individual programming).
• Second, gender differences in access to, participation in and completion of CDSMPs were identified in the literature.  While most of the studies reported higher rates of access and participation by women than men, there is some evidence that men who do enroll in CDSMPs are more likely complete the course. 
• Third, the issue of gender is relevant in considering the outcomes of participation in CDSMPs.  Most of the studies reviewed indicate that women may experience greater benefit from their participation. 
• Fourth, many of the studies included in this review acknowledge that gender intersects in complex ways with other identity characteristics, such as ethnicity/race or age, and may be mediated through other important situational factors, such as economic context.

The preliminary findings from our qualitative study suggest gender differences in communication styles, comfort levels with emotional/sensitive topics, degrees of social support needed; and the social responsibilities of men versus women.  These themes were predominant in the participants’ accounts of variations in participation and engagement in CDSMPs between men and women.  The interviews also revealed that these differences are not absolute.  There were numerous accounts of men who were highly engaged and motivated by their enrollment in the CDSMPs and experienced positive changes as a result.  There were fewer accounts of women who were unsuccessful or unengaged in the CDSMPs.

The results from the secondary data analysis revealed gender differences in the areas of function (physical, social and personal) and hospital utilization.  There were no differences by gender in self-management and self-efficacy scores.  Women report higher functioning and this may be due to more effective engagement in self-management.  These results also reveal the interaction between age and gender as important in explaining variations in scores. 

The following recommendations address the implications of the above preliminary findings for the primary health care system:

• The opportunities for access to CDSMPs within primary care need to be considered in the context of gender;
  
  
• Incorporate gender as one consideration to developing a more flexible approach to the programming of CDSMP;
  
  
• Effective implementation of self-management strategies within Primary Care by persons with chronic disease requires engagement by members of the interdisciplinary healthcare team that requires providers to relinquish established roles, to gain new skills and enter new partnership roles with patients.

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