We propose to adapt, pilot test, and evaluate an evidence-based medical self-management program for use in a Community Mental Health Center (CMHC). The theoretical framework underpinning the study is the Information-Motivation-Behavioral Skills model, developed for changing HIV-Risk behavior and more recently articulated as a general approach to understand and foster health behavior change. The program will be based on the Chronic Disease Self-Management Program (CDSMP), a peer-run disease self-management program demonstrated to improve healthy behaviors and health status among persons with a range of chronic conditions. The proposed project will take a multiphased approach. In the initial phase, qualitative methods will be used to elicit information regarding clients' information, motivation, and behavioral skills regarding self- management and healthy behaviors. This information will be used to guide the adaptation of the CDSMP to the specific needs of the target population, CMHC clients with one or more chronic medical condition. In the next phase, we propose implementing a pilot randomized trial (n=50) to establish feasibility, acceptability, and effect sizes for the intervention compared to usual care. The intervention will comprise a series of peer-led group sessions focusing on medical illness self-management, healthy behaviors, and effective use of the general medical system. Evaluations conducted at baseline and then at 6-month intervals over a 12-month period, will use validated measures to assess health self-efficacy, patient activation, and health behaviors including use of health services. Exploratory analyses will also assess health outcomes and the potential mediating role of information and motivation on the intervention effect. Results from these analyses, supplemented with interviews with participants in the intervention program, will be used to further refine the intervention and to inform planning for a larger trial. This study will be the first to apply a medical disease self-management program to persons with serious mental illness, a population at risk for poor quality of medical care and elevated medical morbidity and mortality. If successful, it may provide a sustainable, scalable model for improving health behaviors in a highly vulnerable population. ? ? ?
