Participation and chronic disease self-management: are we risking inequitable resource allocation?

The Ottawa Charter for Health Promotion supported the empowerment of individuals to participate in their health care and have control over their health. For older adults with chronic conditions, the Chronic Disease Self-Management Program has been widely adopted as an adjunct to existing healthcare options. A growing body of literature has supported the positive impact of self-management programs on outcomes for people with a range of chronic conditions. However, evidence also suggests that participation in these programs is biased. This paper draws on pilot data to describe the profile of those people who inquire, enrol, attend, and complete CDSM courses in Queensland, Australia. As expected, there was evidence that males, Indigenous people, people of non-English speaking background, and those with multiple responsibilities were less likely to participate. Most importantly, participation was affected by a self-selection bias associated with health status. Those who were either unwell or well at the time of the course were unlikely to attend, minimising the preventative value of the CDSM program. Further, CDSM evaluation studies are likely to be inherently flawed and the distribution of health resources can become inequitable