Predictors of Health Self-Management Program Preference Among Lower-to-Middle Wage Employed Adults With Chronic Health Conditions. Academic Article uri icon


  • PURPOSE: We examined the extent to which demographic, chronic disease burden, and financial strain characteristics were associated with a preference for engaging in the Chronic Disease Self-Management Program (presented as a "health self-management program" [HSMP]) over a financial self-management program (FSMP) and a no program preference (NPP) group among employed adults. DESIGN: Cross-sectional, correlation design using baseline data from a randomized controlled trial (RCT). SUBJECTS: The analytic sample included 324 workers aged 40 to 64 years with 1 or more chronic disease conditions recruited into the RCT from 2015 to 2017. MEASURES: Chronic disease burden measures included the number of chronic conditions, body mass index (BMI), and the 8-item and 15-item Patient Health Questionnaire (PHQ-8 and PHQ-15). Financial strain was measured as the inability to purchase essentials and food assistance receipt. Both individual and household measures of income were assessed. ANALYSES: Multinomial logistic regression and post-hoc marginal effects models. RESULTS: Moderate-to-severe depressive symptoms increased the likelihood of having an HSMP preference when compared with those preferring the FSMP (RR = 4.2, P < .05) but not those having NPP; while higher BMI marginally increased HSMP preference over FSMP preference, but not NPP groups (RR = 1.04, P < .05). Financial strain differentially, but significantly, reduces the likelihood of HSMP preference at varying levels of household poverty, depressive symptom severity, and financial strain. CONCLUSION: Middle-aged, lower-to-middle income workers with moderate-to-severe depressive symptoms opt for HSMPs over FSMPs, but preference for HSMPs significantly diminished when they are experiencing financial strain.

published proceedings

  • Am J Health Promot

author list (cited authors)

  • Kneipp, S. M., Horrell, L., Gizlice, Z., Smith, M. L., Linnan, L., & Brady, T.

citation count

  • 2

complete list of authors

  • Kneipp, Shawn M||Horrell, Lindsey||Gizlice, Ziya||Smith, Matthew Lee||Linnan, Laura||Brady, Teresa

publication date

  • February 2019