Evaluation of a SelfManagement Course
Using the Health
Education Impact
Questionnaire
Tiffany Gill
Jing Wu
Anne Taylor
Report by Population Research and Outcome
Studies, University of Adelaide for
Arthritis SA
© 2011
This work is copyright. It may be reproduced and PROS, the School of Medicine at The
University of Adelaide welcomes requests for permission to reproduce in the whole or in part for,
study or training purposes subject to the inclusion of an acknowledgment of the source and no
commercial use or sale.
National Library of Australia Cataloguing-in-Publication entry
Author:
Title:
Gill, Tiffany.
Evaluation of self-management course using the Health education impact questionnaire /
Tiffany Gill ; Jing Wu ; Anne Taylor.
ISBN:
9780987207944 (pbk.)
Subjects:
Arthritis--Patients.
Patient self-monitoring.
Self-care, Health.
Other Authors/Contributors:
Wu, Jing.
Taylor, Anne, 1950Dewey Number:
616.722
--------------------------------------------------------------------------------------------------------------------------National Library of Australia Cataloguing-in-Publication entry
Author:
Title:
Gill, Tiffany.
Evaluation of self-management course using the Health education impact questionnaire
[electronic resource] / Tiffany Gill ; Jing Wu ; Anne Taylor.
ISBN:
9780987207951 (eBook)
Subjects:
Arthritis--Patients.
Patient self-monitoring.
Self-care, Health.
Other Authors/Contributors:
Wu, Jing.
Taylor, Anne, 1950Dewey Number:
616.722
Suggested citation: Gill T, Wu J, Taylor A. Evaluation of a Self-management course using the Health
education impact questionnaire. School of Medicine, University of Adelaide, 2011.
Evaluation of Self Management Course
Page 2
TABLE OF CONTENTS
CHAPTER 1: INTRODUCTION AND METHODOLOGY ..................................................... 7
Introduction................................................................................................................................................ 8
Aim ............................................................................................................................................................. 8
Methodology .............................................................................................................................................. 8
Questionnaires ........................................................................................................................................ 8
Sample selection...................................................................................................................................... 9
Response rates ........................................................................................................................................ 9
CHAPTER 2: DEMOGRAPHIC PROFILE AND TYPE OF ARTHRITIS ...........................11
Introduction.............................................................................................................................................. 12
Age and sex of respondents ...................................................................................................................... 12
Health conditions...................................................................................................................................... 12
How long ago participated in the MTW course ......................................................................................... 14
Severity of condition ................................................................................................................................. 14
Summary .................................................................................................................................................. 16
CHAPTER 3: HEALTH EDUCATION IMPACT QUESTIONNAIRE (HEIQ™) .................17
Health Education Impact questionnaire (heiQ™) ...................................................................................... 18
Positive engagement with life ................................................................................................................... 19
Health directed behaviour ........................................................................................................................ 21
Skill and technique acquisition ................................................................................................................. 24
Constructive attitudes and approaches ..................................................................................................... 26
Self-monitoring and insight....................................................................................................................... 28
Health service navigation.......................................................................................................................... 30
Social integration and support .................................................................................................................. 32
Emotional wellbeing – negative effect ...................................................................................................... 34
Summary .................................................................................................................................................. 35
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Evaluation of Self Management Course
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EXECUTIVE SUMMARY
Executive Summary
Arthritis SA is a leader in conducting self-management courses in South Australia. Known as the
“Moving Towards Wellness” Course (MTW), sessions are conducted throughout the year with
approximately 200 attendees annually.
The aim of this study was to examine whether participants in self-management courses still used
the skills they had learnt and to determine their perception of their current quality of life. The
TM
Health Education Impact Questionnaire (heiQ ) was then used to evaluate the impact of the MTW
course in conjunction with these other factors. The heiQ™ was developed in order to provide a
relevant and valid evaluation and data management system for health education and selfmanagement programs.
Demographic characteristics
 Generally females and those aged over 65 years attended MTW courses.
 While those with arthritis were those who most commonly attended the courses, there were also
participants with a wide range of other conditions.
 Older people (those who were more likely to attend the course) and recent attendees were also
more likely to say that their condition was not severe at the time of attending the course.
Results
 Demographic factors impact on the quality of life following a self management course, as
measured by the heiQTM, with age and severity of the condition generally the most significant
factors.
 Generally, it can be seen that for the eight evaluation domains, as measured by the heiQ TM,
those who were able to do things that they could not do before, were able to exercise, deal with
problems differently, had improve interactions with health care providers, improved quality of
life and life had improved a lot, generally had higher scores. This indicates improvements in
functioning as a result of the self-management course.
Thus, the MTW course does have some benefits as measured by the heiQTM.
Evaluation of Self Management Course
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CHAPTER 1: INTRODUCTION AND
METHODOLOGY
Introduction and methodology
Introduction
Arthritis SA is a leader in conducting self-management courses in South Australia. Known as the
“Moving Towards Wellness” Course (MTW), sessions are conducted throughout the year with
approximately 200 attendees annually. However the impact of the course has not been assessed
since its implementation.
Aim
The aim of this study was to examine whether participants in self-management courses still used
the skills they had learnt and to determine their perception of their current quality of life. The
Health Education Impact Questionnaire (heiQTM) was then used to evaluate the impact of the MTW
course in conjunction with these other factors.
Methodology
Questionnaires
A short questionnaire was designed by the Education and Research Committee of the Board of
Arthritis SA. The questionnaire examined disease severity, skills learnt during the course and
whether these skills were still utilised. A separate report focuses specifically on the responses to
TM
these questions. The Health Education Impact Questionnaire (heiQ ) was chosen to evaluate the
self-management program and examines these responses in conjunction with those obtained from
the questionnaire designed by the Education and Research Committee. The questions used in
TM
conjunction with the heiQ were:
 Sex.
 Age.
 On a scale of 1 to 10 with 1 being not severe at all and 10 being the most severe imaginable, how
would you rate the severity of your condition when you started the “Moving Towards Wellness”
course?
 On a scale of 1 to 10 with 1 being not severe at all and 10 being the most severe imaginable,
how would you rate the severity of your condition now?
 How long ago did you participate in a “Moving Towards Wellness” course?
 Are you still using the skills you learnt?
 As a result of the course, have you been able to do things that you weren’t able to do before?
 As a result of the course do you do more exercise?
 As a result of the course do you deal with problems differently?
 As a result of the course have your interactions with health care providers (including medical
practitioners) improved?
 As a result of the course has your quality of life improved?
 On a scale of 1 to 10 with 1 being not at all, how has your life improved following the “Moving
Towards Wellness” course
 As a result of the “Moving Towards Wellness Course have you used any of the other services
offered by Arthritis SA?
Evaluation of Self Management Course
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Introduction and methodology
Sample selection
All respondents who had attended a MTW course in the last ten years and whose contact details
were recorded by Arthritis SA were eligible to participate. All were sent a copy of the two
questionnaires with an accompanying letter explaining the purpose of the survey. A reply paid
envelope was included. All questionnaires had a number which was linked to the address
database at Arthritis SA. Arthritis SA maintained a list of returned questionnaires and then
provided all deidentified questionnaires for data entry.
Response rates
The response rate has been calculated as shown in Table 1.1. Overall, 701 questionnaires were
sent with six people reporting that they had not done the course, six were deceased and 26
returned to sender, leaving 663 questionnaires in the eligible sample. There was no follow up for
unreturned questionnaires. Overall 244 questionnaires were returned (response rate 36.8%).
Table 1.1: Response rate
n
Eligible sample
Declined
%
663
18
2.7
Not returned
401
60.5
Returned questionnaires
244
36.8
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Introduction and methodology
Evaluation of Self Management Course
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CHAPTER 2: DEMOGRAPHIC
PROFILE AND TYPE OF ARTHRITIS
Demographics
Introduction
This section presents the general information collected from all of the respondents (n=244) in
regards to their demographic profile (age, sex and time since course), the type of arthritis and/or
other health conditions respondents had, and a rating of the severity of their condition.
Age and sex of respondents
Information about age and sex was collected from all respondents (n=244). Results are shown in
Table 2.1. The mean age was 65.33 years (SD 11.274, Range 22-90).
Table 2.1: Sex and age group of respondents
n
%
36
14.8
Females
201
82.4
Refused
7
2.9
Sex
Males
Age group
22 to 44 years
6
2.5
45 to 64 years
102
41.8
65 years or over
135
55.3
Refused
Total
1
0.4
244
100.0
Health conditions
The following table presents the types of arthritis and other health conditions reported by all of the
respondents (n=244) (Table 2.2).
Table 2.2: Arthritis and other health conditions of respondents*
n
%
95% CI
Arthritis and other health conditions*
Osteoarthritis
160
67.2
(60.9 - 73.2)
Fibromyalgia
59
24.8
(19.4 - 30.8)
Rheumatoid arthritis
50
21.0
(16.0 - 26.7)
Osteoporosis
14
5.9
(3.3 - 9.7)
Psoriatic arthritis
11
4.6
(2.3 - 8.1)
Lupus
6
2.5
(0.9 - 5.4)
Sjögren’s syndrome
6
2.5
(0.9 - 5.4)
61
25.6
(20.2 - 31.7)
Other
* Multiple response
Evaluation of Self Management Course
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Demographics
“Other” arthritis and musculoskeletal conditions that the course participants had are listed below:

Paget’s disease (3)

Connective tissue disorder (2)

Scleroderma, Crest (3)

Seronegative synovitis (1)

Scoliosis (3)

Scheuermann's (1)

Unknown type of arthritis (3)

Sciatica (1)

Polymyalgia rheumatica (2)

Bursitis (1)

Inflammatory spondyloarthropathy
(2)

Osteopenia (1)

Calcification of the spine (1)
Disc bulges (2)

Back injury (1)

“Other” health conditions that the course participants had are listed below:

Cardiovascular disease (stroke, high blood pressure, angina, atrial fibrillation) (8)

Depression, chronic fatigue syndrome and bipolar disease (7)

Chronic airway or lung disease (COPD, COAD, bronchiectasis) (6)

Asthma (4)

Colitis (1)

Neuropathic disorder, multiple
sclerosis (3)

Methicillin-resistant Staphyococcus
aureus (MRSA) (1)

Diabetes (2)

Insulinemia (1)

Auto-immune disease (2)

Poliomyelitis (1)

Allergies (1)

Urticaria (1)

Coeliac (1)

Hearing or eye problem (2)
Evaluation of Self Management Course
Page 13
Demographics
How long ago participated in the MTW course
All respondents (n=244) were asked how long ago they participated in the MTW course. The
results are in Table 2.3. The majority of respondents had participated in the course within the last
three years.
Table 2.3: Time since participating the MTW course
Less than one month to three years
n
%
95% CI
131
53.7
(47.2 - 60.1)
More than three years
94
38.5
(32.4 - 44.9)
Don’t know
19
7.8
(4.7 - 11.9)
244
100.0
Total
Severity of condition
All respondents (n=244) were asked to rate, on a scale of 1 to 10, the severity of their condition
when they started the MTW course and the severity of their condition at the time of the survey. All
participants who gave a score for both before the course and now were compared (n=239). The
severity score now was statistically significantly lower compared to at the time of the course
(p<0.01) (Table 2.5).
Table 2.4: Comparison of severity score before MTW course and now
Mean (SD)
When started MTW course
6.2 (2.1)
Now
4.9 (2.5)
p
<0.01
The severity, on a 1-10 scale, was classified into “not severe” (score of 1 to 5) and “severe” (score
of 6 to10). A higher proportion of respondents rated their condition more severe before the MTW
course compared to the now, at the time of the survey (Table 2.5).
Table 2.5: Severity of condition
n
%
95% CI
When started MTW course
Not severe
88
36.5
(30.4 - 42.9)
Severe
153
63.5
(57.1 - 69.6)
Total
241
100.0
142
59.4
(52.9 - 65.7)
97
40.6
(34.3 - 47.1)
239
100.0
Now
Not severe
Severe
Total
Evaluation of Self Management Course
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Demographics
When examining severity at the time of the MTW course, respondents aged 65 years and over,
were less likely to report that their condition was severe and those who had attended the course
more than three years ago were more likely to report that their condition was severe at the time of
the course (Table 2.6).
Table 2.6: Severity of condition when started MTW course by age, sex and when
participated in the MTW course
Not severe
n
Severe
% (95% CI)
n
% (95% CI)
Sex
Males
14
16.3 (9.2 - 25.8)
22
14.8 (9.5 - 21.5)
Females
72
83.7 (74.2 - 90.8)
127
85.2 (78.5 - 90.5)
Total
86
100.0
149
100.0
Age
18 to 44 years
-
6
3.9 (1.5 - 8.3)
45 to 64 years
31
35.2 (25.3 - 46.1)
-
70
45.8 (37.7 - 54.0)
65 years or over
57
64.8 (53.9 - 74.7) ↑
77
50.3 (42.1 - 58.5) ↓
Less than one month to three
years ago
58
65.9 (55.0 - 75.7) ↑
72
47.1 (38.9 - 55.3) ↓
More than three years ago
21
23.9 (15.4 - 34.1) ↓
72
47.1 (38.9 - 55.3) ↑
Time since participation
Don’t know
Total
9
88
10.2 (4.8 - 18.5)
100.0
9
153
5.9 (2.7 - 10.9)
100.0
↓↑ Statistically significantly higher or lower (p<0.05) compared between categories of severity
Evaluation of Self Management Course
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Demographics
There were no significant differences between sex, age group and the time since participating in
the MTW course in terms of the rating of severity at the time of the survey (Table 2.7).
Table 2.7: Severity of condition now by age, sex and when participated in the MTW course
Not severe
n
Severe
% (95% CI)
n
% (95% CI)
Sex
Males
25
18.1 (12.1 - 25.6)
11
11.6 (5.9 - 19.8)
Females
113
81.9 (74.4 - 87.9)
84
88.4 (80.2 - 94.1)
Total
138
95
100.0
100.0
Age
18 to 44 years
3
45 to 64 years
54
38.0 (30.0 - 46.5)
2.1 -
45
3
46.4 (36.2 - 56.8)
3.1 -
65 years or over
85
59.9 (51.3 - 68.0)
49
50.5 (40.2 - 60.8)
Less than one month to three
years ago
76
53.5 (45.0 - 61.9)
53
54.6 (44.2 - 64.8)
More than three years ago
56
39.4 (31.3 - 48.0)
37
38.1 (28.5 - 48.6)
Don’t know
10
7.0 (3.4 - 12.6)
7
7.2 (3.0 - 14.3)
Time since participation
Total
142
100.0
97
100.0
Summary
 Generally females and those 65 years and over attended MTW courses, thus the course is not
targeting males or the younger population.
 While those with arthritis were those who most commonly attended the courses, there were also
participants with a wide range of other conditions, which raises questions of who the course is
being targeted at.
 Older people (those who were more likely to attend the course) and recent attendees were also
more likely to say that their condition was not severe at the time of attending the course.
Evaluation of Self Management Course
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CHAPTER 3: HEALTH EDUCATION
IMPACT QUESTIONNAIRE (HEIQ™)
TM
heiQ
Health Education Impact questionnaire (heiQ™)
The Health Education Impact Questionnaire (heiQ™) was developed in order to provide a relevant
and valid evaluation and data management system for health education and self-management
programs. The questionnaire is composed of eight domains and 40 questions1. All respondents
(n=244) were asked to complete the heiQ™ Version 3 follow up questionnaire. The mean scores
for each of the eight domains are presented in Table 3.1.
Table 3.1: Eight domains of heiQ™
heiQ Domain
1
Mean (SD, range)
Positive and active engagement in life
2.99 (0.38, 1.00 – 4.00)
Health directed behaviour
3.19 (0.51, 1.00 – 4.00)
Skill and technique acquisition
2.87 (0.33, 2.00 – 3.80)
Constructive attitudes and approaches
2.86 (0.40, 1.75 – 3.80)
Self-monitoring and insight
2.74 (0.37, 1.83 – 3.83)
Health service navigation
2.92 (0.35, 1.50 – 4.00)
Social integration and support
2.98 (0.46, 1.40 – 4.00)
Emotional wellbeing
3.97 (0.51, 3.00 – 6.00)
http://www.crd.unimelb.edu.au/heiq/
Evaluation of Self Management Course
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TM
heiQ
Positive engagement with life
This construct covers the motivation to be active and assesses whether participants in selfmanagement/health education programs have engaged or re-engaged in life-fulfilling activities as a
result of the program. The items measure the individuals’ activities to convert intentions into
2
positive outcomes, and imply a change of lifestyle and life activities .
The questions used to measure this construct are:

I am doing interesting things in my life.

Most days I am doing some of the things I really enjoy.

I try to make the most of my life.

I have plans to do enjoyable thing for myself during the next few days.

I feel like I am actively involved in life2.
There was a significant difference between age groups in the mean score for positive and active
engagement in life, with older age groups reporting a lower score compared to the youngest age
group (p=0.02) (Table 3.2).
Table 3.2: Positive and active engagement in life by sex, age group, when participated in the
MTW course, severity of condition, still use skills learnt
Positive and active engagement in life
n
Mean (SD)
p-value
Sex
Male
36
2.89 (0.33)
195
3.02 (0.36)
18 to 44 years
6
3.24 (0.20)
45 to 64 years
100
3.05 (0.31)
65 years or over
131
2.93 (0.42)
Female
0.06
Age group
0.02
Time since participation
Less than one month to three years ago
128
2.99 (0.43)
More than three years ago
92
3.00 (0.32)
Don’t know
18
2.92 (0.25)
88
2.98 (0.35)
149
2.99 (0.40)
141
2.96 (0.36)
94
3.02 (0.41)
Yes
206
2.98 (0.38)
No
16
2.95 (0.31)
0.73
Severity of condition when started the
MTW course
Not severe
Severe
0.75
Severity of condition now
Not severe
Severe
0.25
Still use the skills learnt
Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05
2
http://www.crd.unimelb.edu.au/heiq/ heiQ™ items Version 3
Evaluation of Self Management Course
Page 19
0.78
TM
heiQ
There were no significant differences between mean scores for positive and active engagement in
life for: able to do things that weren’t able to before; able to do more exercise; dealing with
problems differently; having improved interaction with health care providers; having improved
quality of life; life had improved somewhat or a lot; and having used other services offered by
Arthritis SA (Table 3.3).
Table 3.3: Positive and active engagement in life as a result of the MTW course
Positive and active engagement in life
n
Mean (SD)
Yes
112
2.99 (0.43)
No
118
2.99 (0.34)
Yes
149
2.98 (0.41)
No
84
3.00 (0.32)
Yes
168
3.00 (0.39)
No
66
2.95 (0.36)
Yes
152
3.01 (0.41)
No
77
2.93 (0.31)
Yes
152
3.01 (0.39)
No
75
2.98 (0.34)
137
2.96 (0.33)
97
3.03 (0.43)
Yes
100
3.00 (0.39)
No
132
3.00 (0.33)
p-value
Able to do things that weren’t able to
0.95
Do more exercise
0.69
Deal with problems differently
0.32
Improved interaction with health care
providers
0.14
Improved quality of life
0.66
How has life improved
Improved somewhat
Improved a lot
0.17
Have used other services offered by
Arthritis SA
Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05
Evaluation of Self Management Course
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0.94
TM
heiQ
Health directed behaviour
This scale is similar to the first in that it relates to a change in lifestyle, however in this case the
change is tangible and specifically related to healthy behaviours. The activities may include
changes in exercise, relaxation routines and diet which are aimed at either disease prevention and/
3
or health promotion .
The questions used to measure this construct are:
 I walk for exercise, for at least 15 minutes per day, most days of the week.
 I do at least one type of physical activity every day for at least 30 minutes (e.g. walking,
gardening, housework, golf, bowls, dancing, Tai Chi, swimming).
 On most days of the week, I do at least one activity to improve my health (e.g. walking,
relaxation, exercise).
 On most days of the week, I set aside time for healthy activities (e.g. walking, relaxation,
3
exercise) .
Respondents who rated their condition as “not severe” now had a significantly higher score than
those with a “severe” condition and those who still used the skills learnt from the course also had a
significantly higher score for this domain than those who did not still use the skills (Table 3.4).
3
http://www.crd.unimelb.edu.au/heiq/ heiQ™ items Version 3
Evaluation of Self Management Course
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TM
heiQ
Table 3.4: Health directed behaviour by sex, age group, when participated in the MTW
course, severity of condition, still use skills learnt
Health directed behaviour
n
Mean (SD)
36
3.18 (0.39)
194
3.21 (0.51)
18 to 44 years
6
3.33 (0.68)
45 to 64 years
100
3.11 (0.53)
65 years or over
130
3.26 (0.48)
p-value
Sex
Male
Female
0.72
Age group
0.05
Time since participation
Less than one month to three years ago
128
3.19 (0.55)
More than three years ago
91
3.22 (0.47)
Don’t know
18
3.10 (0.46)
0.64
Severity of condition when started the
MTW course
Not severe
88
3.21 (0.44)
148
3.19 (0.55)
141
3.33 (0.44)
93
2.99 (0.54)
Yes
205
3.23 (0.49)
No
16
2.93 (0.61)
Severe
0.71
Severity of condition now
Not severe
Severe
<0.001
Still use the skills learnt
Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05
Evaluation of Self Management Course
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0.02
TM
heiQ
Respondents who were able to do things that they weren’t able to previously; were able to do more
exercise; could deal with problems differently; had improved interaction with health care providers;
had improved quality of life; and whose life had improved a lot as a result of MTW course scored
statistically significantly higher for health directed behaviour (Table 3.5).
Table 3.5: Health directed behaviour as a result of the MTW course
Health directed behaviour
n
Mean (SD)
Yes
112
3.30 (0.51)
No
117
3.10 (0.50)
Yes
148
3.27 (0.51)
No
84
3.07 (0.49)
Yes
167
3.24 (0.51)
No
66
3.06 (0.48)
Yes
152
3.27 (0.50)
No
76
3.01 (0.50)
Yes
152
3.30 (0.50)
No
74
2.98 (0.50)
136
3.07 (0.47)
97
3.36 (0.53)
Yes
99
3.22 (0.53)
No
132
3.19 (0.47)
p-value
Able to do things that weren’t able to
0.002
Do more exercise
0.005
Deal with problems differently
0.02
Improved interaction with health care
providers
<0.001
Improved quality of life
<0.001
How has life improved
Improved somewhat
Improved a lot
<0.001
Have used other services offered by
Arthritis SA
Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05
Evaluation of Self Management Course
Page 23
0.66
TM
heiQ
Skill and technique acquisition
This scale captures the knowledge-based skills and techniques that assist participants to manage
disease related symptoms and health problems more effectively4.
The questions used to measure this construct are:
 When I have symptoms, I have skills that help me cope.
 I have a good understanding of equipment that could make my life easier.
 I have a very good idea of how to manage my health problems.
 I have effective ways to prevent my symptoms (e.g. discomfort, pain and stress) from limiting
4
what I can do in my life .
Females scored statistically significantly higher for skill acquisition compared to males. Those who
did not know when they had participated in the MTW course and those who rated their condition as
severe at the time of the survey scored statistically significantly lower for skill acquisition than the
other respondents (Table 3.6).
Table 3.6: Skill and technique acquisition by sex, age group, when participated in the MTW
course, severity of condition, still use skills learnt
Skill and technique acquisition
n
Mean (SD)
p-value
Sex
Male
36
2.74 (0.29)
196
2.89 (0.34)
18 to 44 years
6
2.87 (0.43)
45 to 64 years
100
2.85 (0.33)
65 years or over
131
2.88 (0.33)
128
2.89 (0.34)
More than three years ago
91
2.88 (0.32)
Don’t know
19
2.66 (0.30)*
88
2.87 (0.34)
149
2.87 (0.33)
142
2.91 (0.33)
93
2.81 (0.33)
Yes
205
2.88 (0.33)
No
16
2.80 (0.38)
Female
0.01
Age group
0.82
Time since participation
Less than one month to three years ago
0.02
Severity of condition when started the
MTW course
Not severe
Severe
0.94
Severity of condition now
Not severe
Severe
0.02
Still use the skills learnt
Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05
4
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TM
heiQ
Respondents who reported they did more exercise; had improved interaction with health care
providers; had improved quality of life; and that life had improved a lot as a result of the MTW
course had significantly higher scores for skill and technique acquisition (Table 3.7).
Table 3.7: Skill and technique acquisition as a result of the MTW course
Skill and technique acquisition
n
Mean (SD)
Yes
111
2.90 (0.35)
No
119
2.84 (0.32)
Yes
148
2.93 (0.34)
No
84
2.77 (0.30)
Yes
166
2.89 (0.34)
No
67
2.81 (0.32)
Yes
152
2.90 (0.36)
No
76
2.79 (0.27)
Yes
152
2.92 (0.34)
No
75
2.78 (0.29)
137
2.79 (0.32)
96
2.98 (0.32)
Yes
99
2.89 (0.35)
No
134
2.85 (0.32)
p-value
Able to do things that weren’t able to
0.17
Do more exercise
<0.001
Deal with problems differently
0.09
Improved interaction with health care
providers
0.01
Improved quality of life
0.001
How has life improved
Improved somewhat
Improved a lot
<0.001
Have used other services offered by
Arthritis SA
Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05
Evaluation of Self Management Course
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0.42
TM
heiQ
Constructive attitudes and approaches
This scale uses the statement “I am not going to let this disease control my life” and measures if
5
there is a shift in how the individual views the impact of their condition(s) on their life .
The questions used to measure this construct are:
 If others can cope with problems like mine, I can too.
 I try not to let my health problems stop me from enjoying life.
 I do not let my health problems control my life.
 My health problems do not ruin my life.
 I feel I have a very good life even when I have health problems5.
Respondents who stated that their condition was “not severe” at the time of survey had a
statistically significantly higher score for constructive attitudes and approaches than those who
stated that their condition was “severe” at the time of survey (Table 3.8).
Table 3.8: Constructive attitudes and approaches by sex, age group, when participated in
the MTW course, severity of condition, still use skills learnt
Constructive attitudes and approaches
n
Mean (SD)
p
Sex
Male
36
2.80 (0.40)
193
2.87 (0.40)
18 to 44 years
6
2.93 (0.50)
45 to 64 years
98
2.78 (0.39)
130
2.92 (0.39)*
Female
0.30
Age group
65 years or over
0.03
Time since participation
Less than one month to three years ago
126
2.88 (0.40)
More than three years ago
91
2.85 (0.41)
Don’t know
18
2.80 (0.36)
87
2.88 (0.37)
147
2.86 (0.41)
141
2.92 (0.36)
91
2.78 (0.44)
Yes
202
2.88 (0.39)
No
16
2.69 (0.45)
0.67
Severity of condition when started the
MTW course
Not severe
Severe
0.69
Severity of condition now
Not severe
Severe
0.006
Still use the skills learnt
Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05
5
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TM
heiQ
Respondents who stated that they did more exercise; had improved interactions with health care
providers; had improved quality of life; and life had improved a lot as a result of the MTW course
had significantly higher scores for constructive attitudes and approaches (Table 3.9).
Table 3.9: Constructive attitudes and approaches as a result of the MTW course
Constructive attitudes and approaches
n
Mean (SD)
Yes
111
2.90 (0.42)
No
115
2.82 (0.39)
Yes
146
2.92 (0.38)
No
83
2.76 (0.42)
Yes
164
2.89 (0.39)
No
66
2.78 (0.42)
Yes
150
2.92 (0.38)
No
75
2.74 (0.42)
Yes
151
2.91 (0.40)
No
73
2.77 (0.40)
135
2.80 (0.40)
96
2.96 (0.39)
Yes
97
2.84 (0.41)
No
133
2.88 (0.40)
p
Able to do things that weren’t able to
0.13
Do more exercise
0.004
Deal with problems differently
0.05
Improved interaction with health care
providers
0.002
Improved quality of life
0.02
How has life improved
Improved somewhat
Improved a lot
0.003
Have used other services offered by
Arthritis SA
Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05
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0.46
TM
heiQ
Self-monitoring and insight
This scale examines the ability to monitor one’s condition, and the physical and/or emotional
responses that lead to insight and the appropriate action or actions to self manage. There needs to
be an acknowledgement of realistic disease-related limitations, and an ability and confidence to
6
remain within these limits .
The questions used to measure this construct are:
 With my health in mind, I have realistic expectations of what I can and cannot do.
 As well as seeing my doctor, I regularly monitor changes in my health.
 I know what things can trigger my health problems and make them worse.
 When I have health problems, I have a clear understanding of what I need to do to control
them.
 I have a very good understanding of when and why I am supposed to take my medication.
 I carefully watch my health and do what is necessary to keep as healthy as possible6.
There were no significant differences in the mean score between groups for self-monitoring and
insight (Table 3.10).
Table 3.10: Self-monitoring and insight by sex, age group, when participated in the MTW
course, severity of condition, still use skills learnt
Self-monitoring and insight
n
Mean (SD)
p
36
195
2.65 (0.41)
2.76 (0.36)
0.10
6
100
130
2.92 (0.49)
2.69 (0.35)
2.76 (0.37)
0.19
Time since participation
Less than one month to three years ago
More than three years ago
Don’t know
127
91
19
2.77 (0.35)
2.71 (0.39)
2.64 (0.29)
0.26
Severity of condition when started the
MTW course
Not severe
Severe
88
148
2.71 (0.37)
2.75 (0.36)
0.34
Severity of condition now
Not severe
Severe
141
93
2.75 (0.37)
2.73 (0.37)
0.67
Still use the skills learnt
Yes
No
204
16
2.74 (0.36)
2.67 (0.38)
0.45
Sex
Male
Female
Age group
18 to 44 years
45 to 64 years
65 years or over
Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05
6
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TM
heiQ
Scores for self-monitoring and insight were significantly higher for those respondents who were
able to: do things that weren’t able to before; do more exercise; and deal with problems differently.
The scores were also higher for those who have improved interactions with health care providers;
have improved quality of life; and for those who had improved a lot as a result of the MTW course
(Table 3.11).
Table 3.11: Self-monitoring and insight as a result of the MTW course
Self-monitoring and insight
n
Mean (SD)
Yes
111
2.79 (0.38)
No
118
2.68 (0.34)
Yes
147
2.79 (0.33)
No
84
2.63 (0.39)
Yes
166
2.76 (0.36)
No
66
2.66 (0.36)
Yes
151
2.80 (0.36)
No
76
2.61 (0.34)
Yes
151
2.79 (0.36)
No
75
2.66 (0.34)
136
2.66 (0.34)
96
2.85 (0.37)
Yes
99
2.74 (0.36)
No
133
2.74 (0.37)
p
Able to do things that weren’t able to
0.02
Do more exercise
0.002
Deal with problems differently
0.04
Improved interaction with health care
providers
<0.001
Improved quality of life
0.008
How has life improved
Improved somewhat
Improved a lot
<0.001
Have used other services offered by
Arthritis SA
Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05
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0.91
TM
heiQ
Health service navigation
This scale examines the understanding of and ability to interact with a range of health
organisations and health professionals. It also measures the ability and confidence to communicate
7
and negotiate with healthcare providers to get needs met .
The questions used to measure this construct are:
 I communicate very confidently with my doctor about my healthcare needs.
 I have very positive relationships with my healthcare professionals.
 I confidently give healthcare professionals the information they need to help me.
 I get my needs met from available healthcare resources (e.g., doctors, hospitals and
community services).
 I work in a team with my doctors and other healthcare professionals7.
Scores for health service navigation were statistically significantly higher for respondents whose
condition was not severe condition at the time of survey (Table 3.12).
Table 3.12: Health service navigation by sex, age group, when participated in the MTW
course, severity of condition, still use skills learnt
Health service navigation
n
Mean (SD)
p
Sex
Male
36
2.86 (0.26)
197
2.94 (0.35)
18 to 44 years
6
3.13 (0.16)
45 to 64 years
100
2.90 (0.35)
65 years or over
133
2.92 (0.35)
129
2.92 (0.35)
More than three years ago
92
2.95 (0.36)
Don’t know
19
2.79 (0.19)
88
2.92 (0.33)
151
2.92 (0.36)
142
2.97 (0.32)
95
2.84 (0.38)
Yes
207
2.92 (0.35)
No
16
2.92 (0.33)
Female
0.20
Age group
0.28
Time since participation
Less than one month to three years ago
0.23
Severity of condition when started the
MTW course
Not severe
Severe
0.90
Severity of condition now
Not severe
Severe
0.006
Still use the skills learnt
Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05
7
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1.00
TM
heiQ
Scores for health service navigation were significantly higher for respondents who reported that
they: were able to do things that weren’t able to before; could do more exercise; could deal with
problems differently; have improved interaction with health care providers; have improved quality of
life; and had improved a lot as a result of the MTW course (Table 3.13).
Table 3.13: Health service navigation as a result of the MTW course
Health service navigation
n
Mean (SD)
Yes
112
2.97 (0.36)
No
120
2.87 (0.34)
Yes
150
2.98 (0.34)
No
84
2.81 (0.33)
Yes
168
2.96 (0.34)
No
67
2.81 (0.32)
Yes
153
2.94 (0.36)
No
77
2.85 (0.29)
Yes
153
2.96 (0.35)
No
76
2.81 (0.32)
138
2.86 (0.30)
97
3.00 (0.38)
Yes
100
2.90 (0.37)
No
134
2.94 (0.31)
p
Able to do things that weren’t able to
0.03
Do more exercise
<0.001
Deal with problems differently
0.002
Improved interaction with health care
providers
0.04
Improved quality of life
0.001
How has life improved
Improved somewhat
Improved a lot
0.002
Have used other services offered by
Arthritis SA
Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05
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0.36
TM
heiQ
Social integration and support
This scale attempts to capture the positive impact of social engagement and support that occurs
through interaction with others and the impact that may arise from associating with others who
share similar health-related life experiences. This also involves the confidence to seek support from
interpersonal relationships as well as community-based organisations on a continuing basis8.
The questions used to measure this construct are:
 I have enough friends who help me cope with my health problems.
 I get enough chances to talk about my health problems with people who understand.
 If I need help, I have plenty of people I can rely on.
 Overall, I feel well looked after by friends or family.
 When I feel ill, my family and carers really understand what I am going through8.
Respondents who stated that their condition was not severe at the time of survey had statistically
significantly higher scores for social integration and support (Table 3.14).
Table 3.14: Social integration and support by age, sex, when participated in the MTW
course, severity of condition, still use skills learnt
Social integration and support
n
Mean (SD)
p
Sex
Males
36
2.98 (0.41)
194
2.98 (0.46)
18 to 44 years
6
3.17 (0.45)
45 to 64 years
100
2.93 (0.45)
65 years or over
129
3.01 (0.45)
126
3.00 (0.48)
More than three years ago
92
2.97 (0.44)
Don’t know
18
2.83 (0.34)
88
3.02 (0.43)
147
2.96 (0.46)
140
3.07 (0.44)
93
2.84 (0.42)
Yes
204
2.99 (0.45)
No
16
2.83 (0.46)
Females
0.94
Age
0.22
Time since participation
Less than one month to three years ago
0.31
Severity of condition when started the
MTW course
Not severe
Severe
0.27
Severity of condition now
Not severe
Severe
<0.001
Still use the skills learnt
Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05
8
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TM
heiQ
Scores for social integration and support were statistically significantly higher for respondents who
reported that they: were able to do things that weren’t able to before, do more exercise, deal with
problems differently. These respondents also had improved interaction with health care providers,
improved quality of life and had improved a lot as a result of the MTW course (Table 3.15).
Table 3.15: Social integration and support as a result of the MTW course
Social integration and support
n
Mean (SD)
Yes
111
3.05 (0.51)
No
117
2.91 (0.38)
Yes
147
3.05 (0.45)
No
84
2.85 (0.42)
Yes
167
3.04 (0.44)
No
66
2.81 (0.43)
Yes
151
3.07 (0.44)
No
77
2.78 (0.40)
Yes
151
3.06 (0.48)
No
75
2.81 (0.38)
137
2.89 (0.42)
96
3.11 (0.47)
Yes
100
2.97 (0.51)
No
131
2.99 (0.41)
p
Able to do things that weren’t able to
0.02
Do more exercise
<0.001
Deal with problems differently
<0.001
Improved interaction with health care
providers
<0.001
Improved quality of life
<0.001
How has life improved
Improved somewhat
Improved a lot
<0.001
Have used other services offered by
Arthritis SA
Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05
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0.67
TM
heiQ
Emotional wellbeing – negative effect
This scale measures the overall negative affective responses to illness, including anger,
9
depression and anxiety, which are attributed to the illness .
The questions used to measure this construct are:
 If I think about my health, I get depressed.
 I get upset when I think about my health.
 I often feel angry when I think about my health.
 My health problems make me very dissatisfied with my life.
 I often worry about my health
 I feel hopeless because of my health9.
Scores for emotional wellbeing were statistically significantly lower for those respondents who did
not have a severe condition at the time of survey (Table 3.16).
Table 3.16: Emotional wellbeing by age, sex, when participated in the MTW course, severity
of condition, still use skills learnt
Emotional wellbeing
n
Mean (SD)
p
Sex
Males
36
4.01 (0.42)
193
3.94 (0.52)
18 to 44 years
6
3.97 (0.53)
45 to 64 years
98
4.01 (0.52)
131
3.92 (0.50)
127
3.93 (0.52)
More than three years ago
91
3.98 (0.51)
Don’t know
18
4.16 (0.42)
87
3.94 (0.46)
148
3.98 (0.54)
141
3.83 (0.48)
92
4.16 (0.49)
Yes
204
3.94 (0.51)
No
16
4.18 (0.57)
Females
0.46
Age
65 years or over
0.40
Time since participation
Less than one month to three years ago
0.17
Severity of condition when started the
MTW course
Not severe
Severe
0.56
Severity of condition now
Not severe
Severe
<0.001
Still use the skills learnt
Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05
9
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TM
heiQ
The scores for emotional wellbeing were statistically significantly lower for respondents who
reported that they: were able to do things that weren’t able to before, do more exercise, or deal with
problems differently. These respondents also had improved interaction with health care providers,
improved quality of life and had improved a lot as a result of the MTW course (Table 3.17).
Table 3.17: Emotional wellbeing as a result of the MTW course
Emotional wellbeing
n
Mean (SD)
Yes
112
3.85 (0.53)
No
116
4.08 (0.48)
Yes
148
3.85 (0.51)
No
83
4.16 (0.47)
Yes
166
3.91 (0.51)
No
66
4.12 (0.48)
Yes
151
3.87 (0.49)
No
76
4.16 (0.51)
Yes
151
3.85 (0.52)
No
74
4.19 (0.43)
136
4.07 (0.46)
96
3.81 (0.54)
Yes
98
3.93 (0.52)
No
132
3.98 (0.50)
p
Able to do things that weren’t able to
0.001
Do more exercise
<0.001
Deal with problems differently
0.006
Improved interaction with health care
providers
<0.001
Improved quality of life
<0.001
How has life improved
Improved somewhat
Improved a lot
<0.001
Have used other services offered by
Arthritis SA
0.52
Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05
Summary
 Demographic factors impact on the quality of life following a self management course, as
TM
measured by the heiQ , with age and severity of the condition generally the most significant
factors.
 Other variables also demonstrated significant differences in scores for each domain except for
positive and active engagement with life.
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