Do Program Implementation Factors or Fidelity Affect Chronic Disease Self-Management Education Programs' Outcomes?

Am J Health Promot. 2017 Sep;31(5):422-425. doi: 10.1177/0890117116664704. Epub 2016 Sep 4.


Purpose: To evaluate whether implementation factors or fidelity moderate chronic disease self-management education program outcomes.

Design: Meta-analysis of 34 Arthritis Self-Management Program and Chronic Disease Self-Management Program studies.

Setting: Community.

Participants: N = 10 792.

Measures: Twelve implementation factors: program delivery fidelity and setting and leader and participant characteristics. Eighteen program outcomes: self-reported health behaviors, physical health status, psychological health status, and health-care utilization.

Analysis: Meta-analysis using pooled effect sizes.

Results: Modest to moderate statistically significant differences for 4 of 6 implementation factors; these findings were counterintuitive with better outcomes when leaders and participants were unpaid, leaders had less than minimum training, and implementation did not meet fidelity requirements.

Conclusion: Exploratory study findings suggest that these interventions tolerate some variability in implementation factors. Further work is needed to identify key elements where fidelity is essential for intervention effectiveness.

Keywords: chronic diseases; community program; implementation factors; program outcomes; self-management.

Publication types

  • Meta-Analysis

MeSH terms

  • Arthritis / therapy
  • Chronic Disease / therapy*
  • Health Behavior*
  • Health Services / statistics & numerical data
  • Humans
  • Mental Health*
  • Motivation
  • Patient Education as Topic / methods*
  • Program Evaluation
  • Self-Management / education*