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BC Self-Management Programs Unsolicited Participant Feedback

2005 – 2010

Self-Management Programs University of Victoria

August 2011

BC Self-Management Programs Unsolicited Participant Feedback

2005 – 2010

Executive Summary Each year, the University of Victoria Self-Management Program Office receives over a hundred

documents (e.g., letters, cards, emails) sent in by program participants and leaders sharing their

thoughts and feelings about the Chronic Disease Self-Management Program (CDSMP). This

feedback is in addition to the standard questionnaires they complete when they start the

program and complete again 6-months post-program. Thus, this feedback is particularly

valuable as it is unsolicited; individuals write in of their own accord rather than at the behest of

program leaders or coordinators. With the goal of best illustrating the meaning participants

attach to the CDSMP, this document presents an analysis of their feedback.

Approximately 500 letters spanning the period between 2005 and 2010 were included and can

be separated into the following categories: letters from participants (74%), letters from

program leaders (14%) and copies of letters addressed to the participants’ doctors (12%).

Through reviewing these feedback documents, a simple coding scheme was developed based

on six reoccurring themes: action plans, empowerment, the book, the group, the leaders and

the health care system. This document presents an overview of themes and sub-themes in

order to provide a more complete picture of CDSMP participants’ experiences.

Participation in the CDSMP is a significant and deeply meaningful experience for many

individuals and is also multifaceted. While questionnaires completed six months following

course completion provide valuable information on program effectiveness, the unsolicited

nature of the feedback analyzed in this document, illustrated with direct quotes from the

participants, attests to the impact and importance individuals attach to the CDSMP. It is

therefore important to summarize this valuable qualitative information in order to ensure the

CDSMP is as effective as possible for participants.

Participant Feedback of CDSMP 1

ANALYSIS OF UNSOLICITED PARTICIPANT FEEDBACK

CHRONIC DISEASE SELF-MANAGEMENT PROGRAM

2005 - 2010

The Chronic Disease Self-Management Program

The Chronic Disease Self-Management program (CDSMP) is a patient education program. This program

is led by pairs of trained lay leaders to groups of ten to sixteen people once each week for 2 ½ hours for

six consecutive weeks. Courses are held in community locations such as recreation centres, community

centres, schools and churches. Each leader successfully completes a four-day training workshop where

he/she learns to follow a scripted manual to lead the course. The courses are then delivered in the

community. Course participants include persons living with chronic health conditions as well as their

families, friends and caregivers. The program teaches the following content: how to develop an exercise

program; using the mind to manage symptoms; healthy eating; breathing exercises; problem solving;

communication skills (with family, friends, and health care providers); use of medication; and how to

deal with the emotions of chronic illness such as anger and depression. The CDSMP does not take the

place of traditional doctor-patient or professional patient education but is complementary to and

reinforces such education. In the program participants obtain new information, learn new skills and

abilities, and develop higher levels of self-confidence (or self-efficacy) to manage and cope with chronic

health conditions.

Key features of self-management education include: led by trained volunteers; highly interactive;

delivered in local settings; provides opportunities for participants to learn from each other; teaches

practical skills needed to manage and cope with conditions on a day-to-day basis; teaches cognitive

techniques; uses ‘best practice’ interventions; strategies and techniques (i.e., it is the process of how the

program is delivered rather than the content of the information presented that is integral); it is

evaluated at several levels; and it encourages the development of individual and community capacity.

Unsolicited Feedback

Each year, the Centre on Aging receives over a hundred documents (e.g., letters, cards, emails) sent in

by program participants and leaders sharing their thoughts and feelings about the CDSMP. This feedback

is in addition to the standard questionnaires they completed when they started the program and

complete again six-months post-program. Thus, this feedback is particularly valuable as it is unsolicited;


individuals write in of their own accord rather than at the behest of program leaders or coordinators.

With the goal of best illustrating the meaning participants attach to the CDSMP, this document presents

an analysis of their feedback. In total, nearly 500 letters spanning the period between 2005 and 2010

were included and can be separated into the following categories: letters from participants (74%),

letters from program leaders (14%) and copies of letters addressed to the participants’ doctors (12%).

Method of Analysis

This document is based on the qualitative methodology of content analysis. Through reviewing CDSMP

feedback documents, a simple coding scheme was developed based on reoccurring themes: action

plans, empowerment, the book, the group, the leaders and the health care system. Separate documents

were created for each of these main themes into which sections of text illustrating the theme were

copied. Text was further analyzed, sorted and pared down to the most relevant direct quotes. As

demonstrated in the following table, each category contained numerous sub-themes. This document

presents an overview of themes and sub-themes in order to provide a more complete picture of CDSMP

participants’ experiences.

Action Plans – 26% Making goals achievable, Taking control of one’s

condition(s), Good for motivation

Empowerment – 36% Empowerment through knowledge, Developing

confidence, Developing a positive attitude

The Book – 27% Use of simple language, To use as a reference, Free

of charge

The Group – 42% To help relieve isolation, Feeling as if you are not

alone, To help develop empathy for others,

Sharing with and learning from one another,

Gaining inspiration and a new perspective,

Developing a sense of camaraderie


The Leaders – 57% Manner of presentation, Included everyone,

Caring, Engaging, Kept things on track, Had chronic

conditions themselves, Were committed, Helped

foster a positive attitude

Health Care System - 4% Excited to be part of a new approach, Addressing

inadequacies and complementing the current

system

Analysis of CDSMP Feedback

1. Action Plans

Out of the topics covered in the CDSMP (ex. diet, exercise, communication), participants frequently

specified action plans as one of their favourite and most beneficial parts of the course. Twenty-six

percent of documents mentioned action plans.

Making goals achievable

Participants often reflected that learning to make action plans resulted in a shift in how they had

previously thought about goal setting. Rather than not doing anything because the goal seemed

overwhelming, the process of breaking goals down through small, short term, achievable and realistic

‘action plans’ was invaluable in getting many participants started.

- I cannot emphasize sufficiently the difference this shift on goal setting makes. Lists and

prioritizing are negative as one rarely manages to complete them. Setting goals and learning

to make them attainable sets one up for a positive results. This has a ripple effect and flows

over into other aspects of one’s life.

- [L]earning that a key to goal setting is that the goal be realistic has changed how I set daily

goals...[and] will assist me greatly as I incorporate them into my routines and habits.

Even when participants faced obstacles in completing their action plans, many still felt the process of

goal setting was beneficial. Goals could always be adapted to ensure a greater likelihood of success.


- [The course] taught me to make a weekly action plan, not to beat myself up if it’s not

followed completely but to start again the next week and try again.

- The plans have not always worked out 100%, but if not perfect today maybe tomorrow will

be a little better and so on.

- I liked the term ‘re-frame.’ Instead of feeling that I had failed at a goal, I could just re-frame

the outcome and see that I had actually made progress, just in a different way.

Taking control of one’s condition(s)

Action plans also played an important role for many participants in learning to take control of their

condition(s).

- This was the beginning of my taking control of my condition. I moved from victim, from

feeling helpless, to feeling that I can do something to alleviate my condition.

- I am confident that I will continue to gain day by day control of my illness by setting weekly

action plans and assessing them.

- Goal setting is important to making a chronic condition manageable and something to strive

towards. This helps to relieve the helplessness we often feel.

Good for motivation

Action plans served as a great source of motivation. Participants reported developing a sense of

responsibility for their plans, both through their commitment to themselves, to the class and to their

‘buddy’.

- The action plan that we did every week was particularly helpful and served as a great

motivator in that I felt that as I had said I would do something specific, I had to make the

effort to complete my task not only for my own benefits but also to be able to say to the

class that I had been successful in doing what I had said I would.

- The weekly ‘action plan’ is a strong motivator to follow through on my verbal commitment

with concrete action. Learning accountability for my health and making resolutions has been

a positive learning experience. I have been challenged and encouraged.


- It was easy to set a goal, but sometimes living up to it was difficult. However, just knowing

that a truthful response was required at the end of the week caused me to use discipline and

adhere to the plan.

- What I liked most was having to make an action plan and phoning a partner mid-week to

report to and then reporting the following week how the action was accomplished. This

process was excellent in learning to form new habits and bring personal responsibility into

play.

2. Empowerment

Given the emphasis of the CDSMP on enabling individuals to become more active managers in their own

health, empowerment frequently emerged as a major category in feedback letters. Thirty-six percent of

documents mentioned empowerment.

Empowerment through knowledge

Participants frequently spoke of gaining a sense of empowerment through learning a ‘toolkit’ of self-

management skills and strategies.

- It gives us more strategies to live a fulfilling life despite our limitations.

- The program enriched my life in participating, learning and applying different effective ways

in improving and achieving a better quality of life without giving up.

- Self-management = self-empowerment and is the only way to go!

Such knowledge was especially important for individuals who felt their lives had become restricted prior

to participation in the CDSMP. Gaining the knowledge and confidence to apply self-management

techniques was often described as becoming ‘unstuck.’

- [S]ince I was diagnosed...I have merely existed with little or no hope of ever again living what

I considered to be a healthy life. However, through this program, I have discovered that in

fact I still may realize a healthy life.

- The program has helped me develop skills to get out of the groove and back into the lane of

living a more fulfilling and productive life.


- I concluded [the course] was all about not being stuck in my condition but finding ways to

move beyond it.

- I would recommend this great course to anyone who, like me, has ‘lost their way.’ It’s a great

was to get ‘back on track.’

Developing confidence

Learning to applying the self-management ‘tool-kit’ was also instrumental in empowering participants to

do more for themselves. Participants reported feeling a greater sense of control and confidence that

they could achieve and manage a healthy life.

- It is a priceless gift to know we can have control over the decisions of one’s condition.

- I now have a new sense of being in control of my life, and the added confidence in self

managing my problems has made me a much happier person.

- I liked the term self-manager. It takes the power away from my psychiatrist, GP, case

manager and the hospital/clinic and puts ME in charge of my care.

- I don’t leave the doctor’s office anymore wondering ‘Did they hear me?’ I am now clear

about the purpose of my visit and I am able to separate the issues that bother me.

- Though you know and I know there is not cure for arthritis pain, it is nice to know I am in

charge of my own destiny when it comes to the pain relief required.

Developing a positive attitude

Accompanying the knowledge and confidence participants in the CDSMP gained was the adoption of a

positive attitude.

- I learned that even with having to live with chronic illness, it is very important to live life to

the fullest, to divert to positive thoughts in order to not dwell on negativity.

- I find the core concept of the course which drives all the tools and techniques presented to

us, namely, the idea of self-empowerment, has shed a new and welcome light into my own

spirit...If I could describe this light, I would call it something like buoyant hopefulness or

optimistic expectancy.


3. The Book

The text, Living a Healthy Life with Chronic Conditions, is provided free of charge to CDSMP participants.

Twenty- seven percent of documents mentioned the book, in which a variety of positive adjectives were

used. These include helpful, informative, interesting, excellent, comprehensive and well written.

- The manual is a wealth of information and loaded with common sense activities. Every

individual should find helpful information no matter their level of pain or disability...There is

so much more for me to learn from this manual and I shall continue to read and gain

knowledge from it for a long time yet.

Use of simple language

The simple and easy to understand language used by the authors to make the text accessible to lay

people was also appreciated.

- It is basic and practical and does not intimidate.

- Thank you for putting this book together in such a way that we can approach each chapter

eagerly instead of some texts which preach, intimidate or talk over our heads.

- The book is a very valuable tool to anyone in plain language to help themselves with chronic

problems and gives one a sense of more control over their health and an inspiration to seek

help when needed. It’s like a friend one can turn to.

As a reference

Participants also felt that rather than feeling pressured to absorb all the information covered at once,

the text would serve as a useful guide, reminder and source of information long after the course was

finished.

- When I get discouraged, I look at [the book] from time to time to see what I can do for

myself.

- When I was first diagnosed with my illness and the medications were prescribed and

discussed I felt overwhelmed and did not absorb all the information provided. Therefore, the

book that is supplied for this course is an excellent reference guide.


Free of charge

As an added bonus, the book was provided for free and was very much appreciated by participants with

lower incomes.

- The book at no cost is greatly helpful to the sadly increasing...number of people who can’t

afford buying books that could help them manage illness better.

- This is important for those like myself who are on disability income.

4. The Group

Of central importance in the CDSMP is the method of program delivery. Classes are delivered to small

groups (preferably ten to sixteen people) where interaction and peer learning are actively encouraged.

This format is frequently appreciated by participants, as demonstrated by the fact that forty-two

percent of feedback letters mentioned the group.

To help relieve isolation

Many participants felt that the experience of simply being among others was helpful in alleviating the

isolation that can often accompany life with chronic condition(s).

- I really have learned how important it is to be part of a group. As a person with several

chronic illnesses you tend to isolate yourself.

- Having been somewhat isolated with no family here, it has been meaningful to meet others

in my community who have similar struggles.

Feeling as if you are not alone

Being around others in similar situations also helped participants realize they were not alone in facing

the challenges of chronic illness.

- [B]eing with other people made me realize I was not the only one with chronic problems.

- [S]ince becoming sick two years ago I had not met other people in similar situations. Though

friends and family offer a great deal of support, I longed to meet and talk to others who

were sharing my struggle. For me this contact with other people with disabilities was the

most important benefit of the course.


To help develop empathy for others

Participants also spoke of developing a sense of empathy for one another. Through discovering

commonalities of experience, they felt they could express their thoughts and feelings knowing others in

the group would understand.

- I find that it is often helpful to be in company with other folks who have chronic

conditions...as there is understanding and empathy. While one does not look for sympathy

from all, on occasion it is good to be among folk who understand without any need for

explanation.

- It was great to be with people who understand when you talk about chronic conditions.

Sharing with and learning from one another

Participants reflected that in addition to the (comfort and understanding) they found in the company of

other group members, discussions and brainstorming allowed them to share their thoughts, feelings and

experiences while generating new ideas to help one another face the challenges of their illness(es).

Sharing with and learning from each other in this manner was invaluable to many participants and often

helped to foster feelings of hopefulness.

- A very important part for me was being with others who have chronic problems. Sharing in a

safe non-judgemental atmosphere is a very comforting and warm experience.

- We all shared our aches and pains. More importantly, we shared ways that these various

conditions can be handled.

- Though the nature of illness in the group varied greatly, it is encouraging to meet others and

discuss the ups, downs, tips and tricks of learning a differed way of living. I no longer feel I

am the only one who is ‘sick,’...[a]nd I have the strength of the group to draw on, to see

possibilities.

- The informal group discussions were very helpful in learning how the others in the group

coped and worked around their chronic conditions. I felt there was such a positive attitude by

everyone.


- For me, this workshop was a support group where I could talk about my emotions and

feelings. It showed me that most of us share the same feelings – damaged goods, fighting a

losing battle, etc. We encouraged each other, reminding ourselves that our health is

otherwise very good, that with good self-care we can continue to live well. We learned to

look at the positive, consider what we did have, what aspects of our health are still working

well and what resources are available to us. We also shared about other activities that were

offered in the community and learned from each other’s experience.

- You couldn’t ask for more sharing or caring people! We shared emotions, predicaments,

upsides and downsides, ideas, information and friendship. Above all the sense of humour

that prevailed was enlightening. It has given me courage to face the future with a more

positive outlook.

Gaining inspiration and a new perspective

Participants also reflected that learning how others were managing their chronic condition(s) helped put

their own problems into perspective. Seeing how others, some with tremendous health challenges,

were coping and succeeding inspired them while providing confidence that they could manage equally

well.

- It helps...to appreciate that many of our fellow men have far greater difficulties. It puts our

own concerns into perspective.

- Your own problems sometimes fade when you hear the experiences of others.

- Meeting my fellow sufferers and admiring how they are managing and looking forward to

positive changes in their lives has re-opened the ‘hope’ door for me and I am eager to get

started putting what I have learned to use.

- My problems are minor compared with most. However, I leave the workshop enlightened.

We are a group that’s full of ideas and compassion.

Developing a sense of camaraderie

Finally, a sense of camaraderie often developed amongst group members. Participants wrote of the

strong connections they forged, the fun they’d had and the new friendships they’d made.


- The atmosphere is quite pleasant as everyone tries to help and encourage each other. ‘The

value of one. The power of many’ applies here too!

- The people were very open.

- [T]his session feels like a ‘big warm hug.’

- Equally remarkable was the interaction among group members. Strangers exchanged

information and became friends, supporters and allies against the ravages of a chronic

illness.

5. Workshop Leaders

Fifty- seven percent of documents mention the leaders as an important component of the CDSMP,

making it the most frequently occurring theme. Numerous positive adjectives were used to describe

leaders. These include sincere, intelligent, compassionate, excellent, dynamic, inspirational, supportive,

and considerate.

Manner of presentation

Many participants appreciated the leader’s clear, straightforward and easy to understand manner of

presentation. Information was communicated in simple language everybody could understand.

- [T]heir explanations and input were clear so that everyone could understand. It made it so you

did not want to miss the next session.

- They presented the material in an easy-going fashion and were very clear with their words...I

was able to listen attentively and the rest of the participants seemed to gain much information

as well.

Included everyone

Others felt that the inclusiveness of the leaders was integral to the course’s success. Everyone was

encouraged to participate.

- The two instructors...complimented each other well and they made sure that we were involved.

They helped all members to share problems, vocalize our pain and apprehensions and come up

with ways to deal with them.


- The facilitators were very helpful and were able to involve everyone in solving problems that

might arise with respect to completing their action plan, and/or in making suggestions to

overcome these problems.

Caring

Participants frequently commented on the caring, kindness and concern demonstrated by the leaders.

- I was very touched by the kindness and compassion shown by our leaders and by their excellent

leadership and facilitation skills.

- Their honest caring means a lot and carries a lot of weight to the people who are taking the

course.

- They are so great to encourage you and support you all the way.

Engaging

Many also felt the leaders were excellent at maintaining class involvement and interest. This was often

accomplished through an enthusiastic attitude, the rapport developed with participants and through a

sense of humour.

- The energy and enthusiasm of the two presenters was what carried the course in my opinion.

They made it so I ‘wanted’ to come back, and made me feel as though I were a vital part of the

group, something not all facilitators can achieve.

- Both volunteer presenters...delivered the material with enthusiasm and empathy, maintained an

upbeat, pleasant atmosphere even in the face of negativity.

- Our instructors...were excellent and added humour and buoyancy for our spirits.

- The instructors...are to be commended for keeping our course fun, even though we’re dealing

with very serious chronic conditions.

- We learned so much from them in a most enjoyable way. The time flew by so fast. We had so

much fun while learning about such a serious and sober subject.

Kept things on track


The leaders’ ability to keep things focused and on track while allowing enough time for often lively

group discussions was commended.

- I was impressed by their caring and their ability to keep the topics on time and on subject while

leaving each person an opportunity to voice their concerns.

- The facilitators were excellent. They did not allow participants to...have a pity-party.’ The

facilitators kept the program on track with a positive attitude.

Had chronic conditions themselves

Participants also appreciated the fact that the leaders themselves had chronic conditions. This allowed

the leaders to speak from personal experience and relate to participants while providing them with

special credibility.

- This lady not only knows the subject, she lives it!

- Your ladies are super...They speak from experience and so you feel that they know how you feel.

- I was very impressed when the two course leaders introduced themselves on the first day and

mentioned that they too were dealing with long-term health problems. It was so refreshing not

to have wonderfully fit young health professionals talking down to us with the arrogance of the

perfectly healthy, to have people who have common experience with us share things which they

know helped them.

Were committed

Many participants commented on the dedication and commitment of the leaders. Their time and energy

facilitating the program was appreciated.

- Although they too have their health problems, they have been there for us all with a smile and

greeting.

- [They] led the sessions with wonderful commitment, care, empathy and professionalism.

- I appreciate much their commitment and how seriously they took their task.

Helped foster a positive attitude


In addition to all the useful things participants learned through the course, many reflected that what

was perhaps most helpful was the positive attitude the leaders helped instill in them.

- They certainly motivate us to feel more positive about our ailments. I know they are correct in

what they say. It is necessary to have people like them around to give us all a nudge to help

ourselves and become more positive citizens.

- They made us realize the importance of positive attitude, the responsibility for our own health,

and presented helpful hints on how to make the most of whatever strengths we still have.

- The leaders...were excellent. They taught us to evaluate our daily living habits, conditions and

circumstances, and, by changing our thinking and attitudes, we were encouraged to reach out

and beyond the more limited lifestyle we had accepted and were becoming accustomed to. With

their help, and that of the others taking the course with us, we now have a more positive and

confident outlook. We are beginning to live a healthy life, even with chronic conditions, and

enjoy the living.

6. Health Care System

A less common theme to emerge in feedback letters was the role of the CDSMP within the health care

system. Although this theme appeared in only four percent of letters, it is important to note that a small

handful of participants expressed excitement that through learning to take greater control of their own

health, they were part of a new approach to health care. They appreciated the provincial government’s

support of the CDSMP.

- In a time where our health care system is scrutinized at every level, the long-term effects of such

a program will be demonstrated by increasing amounts of people taking charge of and being

advocates for their own health.

- It is encouraging that the BC Ministry of Health is attempting to reduce my time in the health

care system through self-management. The whole process has become very empowering for me.

Other BC citizens I have spoken to about the program are also excited that the government is

actively seen to be encouraging us all to be more proactive in our own health and giving us some

training and tools to do so.


- I would strongly recommend that the Ministry of Health Services in BC continue to conduct the

program and to reach out to the many other people in BC towns and cities who are living with

chronic conditions. These people need help, encouragement and direction. The dollars spent up

front will assist in keeping these chronic conditions more under control. This would result,

hopefully, in cost savings to BC’s Heath Care system. There are so many out there, like us, who

need help, encouragement and direction.

Participants also reflected that the CDSMP played an important role in addressing inadequacies and

complementing current approaches in the health care system.

- Programs like this one are vital to help meet health care needs.

- This course was probably compiled to help fill the void in our now existing health care…Our

health care is far below what it should be.

- We’ve had to use self-management skills because of problems in the system in the past.

- The only option is patient education...Until the system begins to address this in programs such as

yours, the unnecessary costs in health care dollars – forget about the loss of work hours, etc. –

will continue to bankrupt the system. We’ll never be able to put the money in fast enough!

- [The course] has a wealth of information and something all doctors should recommend because

it will relieve a lot of questions and also put patients more at ease to know exactly what they

have, what they can do about it and medicines, their reactions and some options.

Conclusion

As the information presented in this report demonstrates, participation in the CDSMP is a significant and

deeply meaningful experience for many individuals. This sense of meaning is multifaceted. Main themes

(action plans, empowerment, the book, the group, the leaders and the health care system) provide a

general framework within which subthemes (e.g., developing a sense of camaraderie, empowerment

through knowledge) vary in importance according to each participant. While questionnaires completed

six months following course completion provide useful information, the unsolicited nature of the

feedback analyzed in this document, illustrated with direct quotes from the participants, attests to the

impact and importance individuals attach to the CDSMP. It is therefore important to summarize this

valuable qualitative information in order to ensure the CDSMP is as effective as possible for participants.


Appendix

The following are examples of letters written by participants after they completed the program.

November 10, 2008

Dr. McGowan

I have been attending the free workshop Living a Healthy Life with Chronic Conditions at Wilson Center in

Port Coquitlam. I wanted to increase my confidence in managing my health to achieve some quality of

life. I did not know what to expect. Since it was free, I decided to sign up, go to the first session and see

for myself.

It was a fun and practical workshop that provided lots of information. It taught me some strategies to

help cope with the physical pain I suffer every day as well as the emotional challenges that come with it. I

did not miss one session, even when I was suffering physical pain, because I knew people would

understand and not judge, etc.

For me, this workshop was a support group where I could talk about my emotions and feelings. It showed

me that most of us share the same feelings – damaged goods, fighting a losing battle, etc. We

encouraged each other, reminding ourselves that our health is otherwise very good, that with good self-

care we can continue to live well. We learned to look at the positive, consider what we did have, what

aspects of our health are still working well and what resources are available to us. We also shared about

other activities that were offered in the community and learned from each other’s experiences. These

women are very courageous and inspiring to me.

I understand now that you could not do it without the volunteers. --- has done an excellent job. She

understands what we go through every day suffering daily pain herself.

The book is a really good reference book and I will try some of the Suggested Further Readings

mentioned in it.

Thank you very much for the opportunity

----


Monday, February 19, 2001

Dear Doctor,

I’ve just completed a excellent six-week workshop offered through the Vancouver/Richmond Health

Board called Living a Healthy Life with Chronic Conditions. While the program is general enough to

include a wide range of chronic conditions, I have found it particularly helpful in teaching me self-

management skills in order to deal with my own chronic health condition.

In hope that some of your other chronic health/pain patients might benefit from this excellent ‘basic

coping skills’ program, here are just a few things that I have both discovered about myself and learned

about self-managing my debilitating condition:

- I’ve learned to move from a place of denial to accepting my condition as a real and serious

chronic pain condition that required me to take control of it instead of it controlling my life.

- I’ve discovered that many of the mental and psychological side effects of my condition (e.g.

depression, apathy, hopelessness, frustration and anger) are all part of the chronic pain cycle,

and that with proper awareness and attention, the affects of this pain cycle can be greatly

reduced or eliminated by the techniques taught in this course.

- I’ve realized how much negative self-talk plays a role in limiting my ability to deal effectively with

my condition. And through consciousness-raising self-talk and visualization techniques taught in

the course, I’m leaning to positively impact all aspects of my chronic pain condition.

- I’ve realized that, even though many times I don’t feel like doing it, this program consistently

stresses the importance of using flexible, achievable goal setting and action planning as a way to

stay active. And the benefit of staying active is a more positive, and self-responsible attitude that

empowers me to effectively both manage my pain and life activities.

- One of the biggest benefits that I’ve gotten from taking this course is becoming more physically

active. By setting realistic goals, and having alternatives in case my original goals need

adjusting, I’ve been able to incorporate physical exercise (e.g. walking, yoga, specific stretching

exercises, meditation, etc.) on a much more consistent basis than I have in the past.

- And finally, the greatest gift that I’ve received by taking this course is meeting and sharing

similar life experiences with a group of intelligent, energetic, courageous, and wonderful people


who each bring their own style, creativity, and determination to bear when dealing with their

own chronic pain conditions. The level of sharing among the facilitators and class participants

has been invaluable. It has helped each of us reinforce the use of the many newly learned skills.

In closing, I’d highly recommend this course to anyone who has been looking for solutions from the

medical establishment and who may not yet realize (as I did for so many years) that the true

solutions to managing chronic pain in our life begin and end within ourselves.

Warm regards,

-----

December 10, 2003

Dear Course Providers,

Thank you for providing the chronic disease self-management program Living a Health Life with Chronic

Conditions.

I am 27 years old and since becoming sick two years ago had not met other people in similar situations.

Though friends and family offer a great deal of support, I longed to meet and talk to others who were

sharing my struggle. For me this contact with other people with disabilities was the most important

benefit of the course. Though the nature of illness in the group varied greatly, it is encouraging to meet

others and discuss the ups, downs, tips and tricks of learning a different way of living. I no longer feel I

am the only one who is ‘sick,’ which is hard to avoid when surrounded by ‘well-ies.’ And I have the

strength of the group to draw on, to see possibility.

Other than the group contact, the most beneficial part of the course for me was goal-setting; learning

that a key to goal setting is that the goal be realistic has changed how I set daily goals. The unit on self-

talk was equally instructive. These tools will assist me greatly as I incorporate them into my routines and

habits.

Other areas such as nutrition, and the section on living wills, I found didn’t apply to me, or, as in the case

of nutrition, I am already very knowledgeable in the area. However, they did apply to the majority of the

group and review can always be helpful.


In closing, I would like to add that the instructors were exceptional in manner of teaching, management

of group dynamics and – most importantly – always realistic but also encouraging in how they deal with

their own conditions. This, perhaps above all else give me hope!

Though there was not much in the course content that was new information to me, stopping to work

through topics in group discussion and practical applications has helped give me a amore concrete set of

tools for recognizing and handling different aspects of my condition. For that I thank you.

Sincerely,

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