Shawn M Kneipp1, Lindsey Horrell1, Ziya Gizlice2, Matthew Lee Smith3, Laura Linnan4, Teresa Brady5. 1. 1 School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 2. 2 Health Promotion and Disease Prevention Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 3. 3 Center for Population Health and Aging, Texas A&M University, and the College of Public Health, The University of Georgia, Athens, GA, USA. 4. 4 Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 5. 5 Clarity Consulting and Communications, Atlanta, GA, USA.
Abstract
PURPOSE: We examined the extent to which demographic, chronic disease burden, and financial strain characteristics were associated with a preference for engaging in the Chronic Disease Self-Management Program (presented as a "health self-management program" [HSMP]) over a financial self-management program (FSMP) and a no program preference (NPP) group among employed adults. DESIGN: Cross-sectional, correlation design using baseline data from a randomized controlled trial (RCT). SUBJECTS: The analytic sample included 324 workers aged 40 to 64 years with 1 or more chronic disease conditions recruited into the RCT from 2015 to 2017. MEASURES: Chronic disease burden measures included the number of chronic conditions, body mass index (BMI), and the 8-item and 15-item Patient Health Questionnaire (PHQ-8 and PHQ-15). Financial strain was measured as the inability to purchase essentials and food assistance receipt. Both individual and household measures of income were assessed. ANALYSES: Multinomial logistic regression and post-hoc marginal effects models. RESULTS:Moderate-to-severe depressive symptoms increased the likelihood of having an HSMP preference when compared with those preferring the FSMP (RR = 4.2, P < .05) but not those having NPP; while higher BMI marginally increased HSMP preference over FSMP preference, but not NPP groups (RR = 1.04, P < .05). Financial strain differentially, but significantly, reduces the likelihood of HSMP preference at varying levels of household poverty, depressive symptom severity, and financial strain. CONCLUSION:Middle-aged, lower-to-middle income workers withmoderate-to-severe depressive symptoms opt for HSMPs over FSMPs, but preference for HSMPs significantly diminished when they are experiencing financial strain.
RCT Entities:
PURPOSE: We examined the extent to which demographic, chronic disease burden, and financial strain characteristics were associated with a preference for engaging in the Chronic Disease Self-Management Program (presented as a "health self-management program" [HSMP]) over a financial self-management program (FSMP) and a no program preference (NPP) group among employed adults. DESIGN: Cross-sectional, correlation design using baseline data from a randomized controlled trial (RCT). SUBJECTS: The analytic sample included 324 workers aged 40 to 64 years with 1 or more chronic disease conditions recruited into the RCT from 2015 to 2017. MEASURES: Chronic disease burden measures included the number of chronic conditions, body mass index (BMI), and the 8-item and 15-item Patient Health Questionnaire (PHQ-8 and PHQ-15). Financial strain was measured as the inability to purchase essentials and food assistance receipt. Both individual and household measures of income were assessed. ANALYSES: Multinomial logistic regression and post-hoc marginal effects models. RESULTS: Moderate-to-severe depressive symptoms increased the likelihood of having an HSMP preference when compared with those preferring the FSMP (RR = 4.2, P < .05) but not those having NPP; while higher BMI marginally increased HSMP preference over FSMP preference, but not NPP groups (RR = 1.04, P < .05). Financial strain differentially, but significantly, reduces the likelihood of HSMP preference at varying levels of household poverty, depressive symptom severity, and financial strain. CONCLUSION: Middle-aged, lower-to-middle income workers with moderate-to-severe depressive symptoms opt for HSMPs over FSMPs, but preference for HSMPs significantly diminished when they are experiencing financial strain.
Entities:
Keywords:
chronic disease; financial strain; health disparities; self-management; symptom burden
Authors: Fiona Cocker; Angela Martin; Jenn Scott; Alison Venn; Kristy Sanderson Journal: Int J Environ Res Public Health Date: 2013-10-15 Impact factor: 3.390
Authors: Matthew Lee Smith; Mark G Wilson; Melissa M Robertson; Heather M Padilla; Heather Zuercher; Robert Vandenberg; Phaedra Corso; Kate Lorig; Diana D Laurent; David M DeJoy Journal: Int J Environ Res Public Health Date: 2018-04-25 Impact factor: 3.390