Harvest Health: Translation of the Chronic Disease Self-Management Program for Older African Americans in a Senior Setting

Chronic health conditions are the major causes of illness, disability, and death among older people, with African Americans bearing a greater burden compared to Whites (Robert Wood Johnson Foundation and the Foundation for Accountability, 2001). African Americans have poorer physical health and greater functional disability (Gitlin, Hauck, Dennis, & Schulz, 2007); are at higher risk for disabling conditions (Ory, Lipman, Barr, Harden, & Stahl, 2000); and have more serious conditions, including stroke, diabetes, cancer, and cardiovascular disease (Committee on Quality of Health Care in America, 2001; Swift, 2002). Additionally, compared to Whites, African Americans have limited access to chronic disease self-management programs (Becker, Gates, & Newsom, 2004) due to multiple social structural barriers including low income, low home ownership, and high unmet housing needs, all contributors to health problems (Kelley-Moore & Ferraro, 2004). Furthermore, African Americans represent an increasing percentage of the aging population and the oldest old, a group at greatest risk for chronic diseases and the highest users of health services. Philadelphia exceeds national trends, with African Americans representing the largest racial/ethnic minority group (35%) of the aging population. Moreover, Philadelphia’s elderly race composition is expected to shift within the next decade with the current White majority becoming a minority (Glicksman & Norstrand, 2004). Given associated health care costs and the impact of chronic illness on life quality, developing strategies for helping people manage chronic diseases and addressing health disparities are important public health priorities. Research has shown that with training and support, persons with chronic disease can learn strategies to effectively self-manage their illness symptoms and that self-management results in important benefits, including decreased service utilization (Chodosh et al., 2005; Goetzel et al., 2007; Ozminkowski et al., 2006; Wagner et al., 2001). Research has shown one patient education approach, the Chronic Disease Self-Management Program (CDSMP), to improve health status and self-efficacy and reduce health care utilization (Lorig, Ritter, et al., 2001; Lorig, Sobel, Ritter, Laurent, & Hobbs, 2001; Lorig et al., 1999).