The Effect of a Chronic Disease Self-Management Curriculum on the Mental Well-being of Persons Living with Lymphatic Filariasis in Léogâne, Haiti Open Access

Bryan, Cassandra (Spring 2021)

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Introduction: Lymphatic filariasis (LF), a neglected tropical disease that can cause permanent disfigurement and disability, has a significant psychosocial burden that is often overlooked in LF treatment and morbidity management. A potential intervention that could address the psychosocial impact of LF infection is the Chronic Disease Self-Management (CDSM) program, a peer-led education program that teaches skills to better manage participants’ chronic conditions and build their confidence.

Purpose: The purpose of this study is to assess the effectiveness of the six-week CDSM curriculum on the mental well-being of people living with lymphatic filariasis in Léogâne, Haiti.

Methods: The CDSM intervention was administered to 118 people with LF through Hope Clubs, which are support groups for people living with LF, in a stepped-wedge cluster randomized trial at the Hôpital Ste. Croix. After four months, their outcomes were compared with wait-listed control participants (n=93) using multiple linear and logistic regression modeling. 

Results: Participants in the Intervention Arm had significant improvements in self-efficacy (β = 0.6, p-value = 0.004), but no significant improvements in depression or perceived social support. The effect of the intervention on all outcomes was not modified by participant age except for symptoms of depressive illness; older individuals had lower odds of reporting an improvement in their depressive symptoms after receiving the intervention than those who were among the youngest age bracket (age 18-34 years old). A per-protocol analysis suggested that high attendance for a majority of the training sessions may not be required to see significant improvement in self-efficacy (β low attendance = 0.8, p-value = 0.002; β high attendance = 0.4, p-value = 0.059).

Conclusion: The psychosocial burden of lymphatic filariasis can be partially addressed using the CDSM program. Future research is needed to evaluate the CDSM intervention among larger sample sizes of people living with LF, as well as people living with other neglected tropical diseases.

Table of Contents

Background 1

Methods 13

Results 20

Discussion 26

Public Health Significance 30

References 31

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