This document summarizes a study examining the availability of evidence-based disease self-management programs and promising practices for older adults in Orange County, California. The study found that while 16 of the 21 organizations surveyed provide such programs, 15% are unable to meet demand. Barriers to implementation included lack of funding and trained leaders. The document concludes that efforts to provide these programs are currently segmented and that future research should explore ways to improve coordination and fill service gaps.

1. A County Approach to Disease Self-
Management in Orange County, California
Katelynn Peirce, MPHc | Jennifer Piazza, Ph.D. | California State University, Fullerton
Abstract
Introduction: Improving wellbeing and QOL among older adults (65+) was
identified as a priority area in the Orange County Health Improvement Plan for
2014-2016. Promoting evidence-based (EB) programs and promising practices (PP)
for disease self-management is a short-term, achievable strategy, aiming to reduce
complications from chronic disease. Currently, there is no standard method of
disseminating information about program availability, recruitment, or benefits for
participants.
Objectives: The purpose of this study is to identify gaps in service and establish the
availability of EB programs and PP in Orange County, California.
Methods: Cross-sectional data was collected from healthcare organizations,
agencies, and service providers throughout the region.
Results: 16 of 21 organizations provide disease self-management EB programs or
PP and 15% of respondents indicated they were unable to meet demand.
Discussion: Program efforts are segmented. Future efforts should develop a
method for disseminating program information to older adults and organizations
within Orange County.
Background and Significance
• Approximately, 12.4% of Orange County (OC) residents are 65 and
over1
• By 2030, 21% of OC residents will be 65+ and most will be managing at
least one chronic condition2-3
• Chronic conditions are the leading indicators for physical limitations
and disability4
• Self-management programs have been used to prevent comorbidity
and disability due to chronic disease
• Orange County Health Improvement Plan for 2014-20165
- Goal 1: Improve wellness and QOL of older adults in OC
- Objective 1.2 : Reduce health complications of chronic diseases
among older adults
- Short-term Strategy: Promote evidence-based programs and
promising practices for disease self-management
Purpose and Hypothesis
To Identify gaps in services and establish the availability of evidence-based
(EB) programs and promising practices (PP) in Orange County, California
H1: There are gaps in services and availability of EB programs and PP for
disease self-management within Orange County
H2: There is a lack of consensus on the best approach for EB programs and
PP for disease self-management within Orange County
Method
Data Collection
Data / Observations
• Analysis based on 21 organizations focusing on disease self-
management programs
• Population served – 416,330 (75% over 60 years of age)
• Over 60 attending programs – 2,390
Results
• Underserved populations identified as homeless, minority groups, and
those with mental health issues
• Lack of funding and trained leaders/instructors are the most common
barriers to implementing EB programs or PP
• H1: Partially supported, some organizations report being unable to
meet demand for programs
• H2: 16 of 21 organizations provide EB programs or PP (5 EB, 1 PP)
Conclusion
• Efforts are segmented for providing disease self-management EB
programs and PP within Orange County
• This contributes to organizations’ inability to meet the demand for
programs and underserved populations
• Future research should explore ways to bolster the response rate and
examine geographic dispersion of available programs in concert with
estimated population of need
References
1. U.S. Census Bureau. (2014). American fact finder. Washington, D.C.: U.S. Department of Commerce. Retrieved from
http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk
2. California Department of Finance. (2016). Demographic Research Unit. Retrieved from
http://www.dof.ca.gov/research/demographic/projections/
3. Ward, B.W., Schiller, J.S., Goodman, R.A. (2014). Multiple chronic conditions among U.S. adults: A 2012 update.
Preventing Chronic Diseases, 11, 1-4. doi: 10.5888/pcd11.130389
4. Brown, P.M., Gonzalez, M., & Dhaul, R.S. (2015). Cost of chronic disease in California: Estimates at the county
level. Journal of Public Health Management & Practice, 21(1), 10-19. doi:10.1097/PHH.0000000000000168
5. Orange County Health Care Agency, Public Health Services. (2014). Orange County Health Improvement Plan
2014-16. Retrieved from http://ochealthinfo.com/about/admin/pubs/OCHealthImprovementPlan
• Participants – Organizations that provide services to older adults within
Orange County
• Sampling Strategy – Convenience sampling via email list-serve
• Response Rate – 24%
• Collaboratively developed new instrument in conjunction with OCHAI, OoA,
and CSUF
• Data collected at aggregate level from each organization
• Data presented is part of a larger study
258
Email Invitations
195
Did not respond
63 Respondents
6 Incomplete
responses
7 Repeat responses
50 Valid responses
Hispanic
27%
White
44%
NH/API
1% NA/AN
1%
Black
3%
Asian
19%
Unknown
5%
RACE/ETHINICITY OF OLDER ADULTS SERVED
31% 28% 31%
10%
29%
46%
56%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Fall Prevention Physical Activity Health Promotion
& Disease
Prevention
Disease Self-
Management
Caregive Support Stress Reduction
& Mental Health
Alcohol &
Substance Abuse
ABILITY TO MEET THE DEMAND FOR PROGRAMS
Missing Exceed Demand Meet Demand Cannot Meet Demand
N = 29 N = 29 N= 35 N=21 N=21 N= 22 N=9