Table 3. Overall Effect Size^a at 4 to 6 Months, by Delivery Mode, Meta-Analysis of the Chronic Disease Self-Management Program, Studies Published 1999–2009.

Outcome	English-Speaking Small Group (n = 15)	Spanish-Speaking Small Group (n = 2)	Small Group Translation (n = 1)	Internet Delivery (n = 2)	Individual In-home (n = 2)	Between-Groups P Valueb
Health behavior
Aerobic exercise	0.12c	0.33c	—	0.09	—	.05
Cognitive symptom management	0.26c	—	0.39c	0.16	—	.54
Communication with physician	0.25c	0.16	—	0.22	—	.84
Stretching/strengthening exercise	0.12	—	—	0.17	—	.63
Psychological health status
Depressiond	−0.22c	—	−0.08	—	<.001	.06
Health distressd	−0.28c	−0.55c	−0.20	−0.26c	—	.17
Overall self-efficacy	0.34c	0.37c	0.39	0.24	0.14	.82
Self-efficacy for chronic disease management	0.26c	—	—	—	—	—
Self-efficacy for management of other symptoms	0.28c	—	—	—	—	—
Physical health status
Energy	0.16c	—	0.39c	—	—	.23
Fatigued	−0.15c	−0.12	−0.24c	−0.14c	—	.85
Functional disabilityd	−0.05	—	−0.08	−0.02	−0.001	.92
Paind	−0.16c	−0.28c	—	−0.11c	—	.04
Self-rated health	0.14c	0.31c	0.39c	0.01	—	.16
Social role limitationsd	−0.17c	−0.30c	−0.18	—	—	.06
Shortness of breathd	−0.13c	−0.20	−0.04	−0.12	—	.84
Health care utilization
Emergency department visitsd	−0.02	−0.10	−0.04	−0.06	—	.81
Physician visitsd	−0.05	0.02	−0.12	−0.07	—	.87
Hospitalization days or nightsd	−0.08c	−0.02	—	0.05	—	.17
Hospitalization timesd	−0.01	—	—	−0.003	—	.92

Abbreviation: —, data not reported.

^a Effect size is the combination of the standardized differences in means for all eligible studies.

^b Determined by Q test for between-groups heterogeneity.

^c P < .01, determined by z score test for significance of pooled effect size.

^d Negative effect size indicates positive effect (eg, a decrease in depression).