Enhancing self-management of multimorbidity in primary care

Exploratory study:
The Frenchay Activities Index (FAI) is a self-report questionnaire designed to measure participation in social and instrumental activities of daily living. It measures how often the person has engaged in these activities (in the past 3 or 6 months depending on the nature of the activity). The measure contains 15 items divided into three sub scales (domestic chores, leisure work and outdoor activities) with five items in each. Measured at baseline (before programme commenced) and and two weeks post intervention at follow-up.

Follow-up study:
1. The EQ-5D (quality of life measure) is a valid and reliable self report questionnaire which measures current health related quality of life (Aggarwal, 2009). It is a two-part measure consisting of a self-reported description (EQ-5D) and self-rated valuation (EQ-VAS).
2. The Frenchay Activities Index (activity participation) is a self report questionnaire designed to measure frequency of participation in social and instrumental activities of daily living and contains 15 items divided into 3 sub scales (domestic chores, leisure work and outdoor activities) with 5 items in each (Miller, Deathe & Harris, 2004).

To be measured at baseline (before the programme commences), immediately post-intervention and 6 months post intervention.

Exploratory study:
1. The Canadian Occupational Performance Measure (COPM) is a client-centered outcome measure designed for use by occupational therapists to detect change in a client's self-perception of occupational performance over time. The COPM is a standardsed instrument administered in a semi-structured interview format at the beginning and end of OT intervention. Areas assessed using the COPM include the client's most important problems in occupational performance, perceptions of their performance in these activities and their level of satisfaction with their performance.
2. The Nottingham Extended Activity of Daily Living Scale (NEADL) is a self-report scale measuring performance of activities of daily living, comprised of 22 items divided into four sections mobility, kitchen, domestic and leisure. Each item is given one of four responses (able, able with difficulty, able with help, unable)
3. Hospital Anxiety and Depression Scale is a reliable and valid self-assessment scale used to detect and indicate the severity of anxiety and depression in a hospital medical outpatient setting and was utilised in the previous research study. It consists of two subscales, anxiety (HADS-A) and depression (HADS-D) with seven items in each.
4. Stanford Chronic Disease Self-Efficacy Scale (6-item) measures study participants' confidence levels in managing various elements of their chronic diseases such as exercise, social activities, household tasks, medication management and symptom management.
5. EQ-5D (Euroqol) is a valid and reliable self report questionnaire which measures current health related quality of life. The EQ-5D is a self report questionnaire for describing and valuing health-related quality of life (Aggarwal, 2009). It is a two-part measure consisting of a self-reported description (EQ-5D) and a self-rated valuation (EQ-VAS). The self reported description (EQ-5D) comprises five questions on mobility, self care, pain, usual activities, and anxiety/depression. The self rated valuation uses a vertical visual analogue scale (EQ-VAS) in which respondents rate their health today
6. The Health Education Impact Questionnaire (HeiQ) is an outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions. The HEIQ contains 40 items on a 4-point Likert scale, measuring eight independent constructs. The areas covered by this assessment include positive and active engagement in life, health-directed activities, skill and technique acquisition, constructive attitudes and approaches, self-monitoring and insight, health service navigation, social integration and support and emotional distress.
7. Goal Attainment Scale (GAS) is a standardised method of scoring the extent to which patient's individual goals are achieved in the course of intervention. The goals, which reflect what the patient wishes to achieve, are defined and quantified by five indicators of potential outcome, ranging from -2 to 2.
8. Health care utilization (based on patient self-report):
8.1. GP visits in previous 6 months
8.2. PN visits in previous 6 months
8.3. Hospital admissions in previous 6 months

All above outcomes measured at baseline (before programme commenced) and and two weeks post intervention at follow-up.

Follow-up study:
1. The Stanford Chronic Disease Self-Efficacy Scale (self-efficacy) measures confidence levels in managing various elements of chronic diseases such as exercise, social activities, household tasks, medication management and symptom management.
2. Canadian Occupational Performance Measure (occupational performance/satisfaction) is a client-centred outcome measure designed for use by occupational therapists to detect change in a client's self-perception of occupational performance over time.The COPM is a standardized instrument administered in a semi-structured interview format at the beginning and end of OT intervention.
3. The Nottingham Extended Activities of Daily Living (activity independence) is a self-report scale measuring performance of activities of daily living, comprised of 22 items divided into four sections mobility, kitchen, domestic and leisure.
4. The Hospital Anxiety and Depression Scale (anxiety and depression) is a reliable and valid self-assessment scale used to detect and indicate the severity of anxiety and depression in a hospital medical outpatient setting.
5. The Goal Attainment Scale is a standardised method of scoring the extent to which patient’s individual goals are achieved in the course of intervention.
6. Health Care Utilisation (based on patient self-report)
6.1. GP visits in previous 6 months
6.2. Number of visits to PCT professionals in previous 6 months
6.3. Number of OPD speciality visits in previous 6 months
6.4. Hospital admissions in previous 6 months (number of admissions and number of days spent in hospital)

Measured at baseline (before the programme commences) and 6 months post intervention