Background: Social comparisons influence self-evaluation and social and psychological adjustment to illness but are under-explored in relation to self-skills training group situations.

Methods: A longitudinal qualitative study embedded within an RCT of a national programme of lay led self-care support in England (Department of Health, 2001). In-depth interviews were undertaken with a purposeful maximum variation sample of recruits. Data were analysed thematically. Three key themes emerged highlighting (1) the experience of group participation and interaction, (2) the process and (3) function of social comparison.

Results: Data highlight the salience of social comparison as an underlying feature of the group dynamics of self-care skills training. The nature, dimensions and scope of social comparisons extend beyond the cognitive states and dimensions traditionally forming the focus of social–psychological approaches to social comparison to include wider dimensions including entitlement to resources. The results confirm the tendency to make positive comparisons that result in beneficial self-evaluations. However, positive comparisons allow respondents to present themselves as socially and morally worthy, which may act to mask the identification of appropriate need and inequalities.

Conclusion: Social comparisons function both as an accurate representation of internal cognitive states but also constitutes identity work involving competing values and moral requirements. We show that even those who report significant needs will sometimes portray themselves in a way that suggests positive social comparisons, which fit with a rationed and morally prescriptive and acceptable view of entitlement to NHS services. Such insights suggest that social comparisons in initiatives such as the EPP may be beneficial for some but exacerbate rather than alleviate health inequalities in long-term condition management for others.

Objectives: Lung Volume Reduction Surgery and Endo-Bronchial Valve^TM insertion have expanded the therapeutic choices for chronic obstructive pulmonary disease (COPD). Controversy over efficacy, costs and risks limits access to these therapies. There are no published findings to guide our understanding of the patient’s experience of surgery. The aim of this study is to understand the experience of palliative surgery for COPD.

Methods: Merleau-Ponty’s philosophy provided a framework for this Heideggerian phenomenological inquiry. Fifty-eight semi-structured interviews were conducted with 15 patients undergoing lung volume reduction procedures and 14 family members.

Results: Patients and families felt they had no option but to ‘take a chance’ on surgery. Interventions frequently led to regaining lost tasks or easier completion of existing tasks. Where patients did not perceive an increase in things they could ‘do’, surgery allowed some to reclaim their sense of self. Regardless of the outcome, most did not regret their decision for surgery.

Discussion: Meanings of surgery are not always tied to the visible, objective measurements of outsiders but may relate to regaining of self. Despite the concerns of some clinicians, patients and families are more likely to accept the risk of morbidity and mortality from surgery than has previously been realized.

Self-care management is essential for effective chronic disease management. Yet prevailing approaches of healthcare practitioners often undermine the efforts of those who require on-going medical attention for chronic conditions, emphasizing their status as patients, failing to consider their larger life experience as people, and most importantly, failing to consider them as people with the potential to be partners in their care. This article explores two approaches for professional–patient interaction in chronic disease management, namely, patient-centred care and empowering partnering, illuminating how professionals might better interact with chronically ill individuals who seek their care. The opportunities, challenges, theory and research evidence associated with each approach are explored. The advantages of moving beyond patient-centred care to the empowering partnering approach are elaborated. For people with chronic disease, having the opportunity to engage in the social construction of their own health as a resource for everyday living, the opportunity to experience interdependence rather than dependence/independence throughout on-going healthcare, and the opportunity to optimize their potential for self-care management of chronic disease are important justifications for being involved in an empowering partnering approach to their chronic disease management.

Objectives: The Patient Assessment of Chronic Illness Care (PACIC) was developed for measuring the extent to which patients receive care congruent with the chronic care model (CCM). The purpose of this study was to develop a short version of the PACIC with better psychometric properties than the original instrument.

Methods: Two samples of 529 and 361 type 2 diabetic patients completed a modified PACIC. A short-version PACIC instrument was developed and validated using parallel analysis to determine the number of factors, confirmatory factor analysis (CFA) within an exploratory factor analysis framework (E/CFA) was conducted to explore the measurement structure of the full instrument, and a CFA was performed to confirm the hypothesized structure.

Results: The results demonstrated that the PACIC is unidimensional and that it can be reduced to 11 items with no loss in psychometric properties. No demographic variables or clinical assays were found to be related to the PACIC.

Discussion: A short-version PACIC is now available and ready for use in research with diabetic patients. Its use is encouraged in future research, particularly in the exploration of its validity against actual CCM services delivered and long-term clinical outcomes.

The present study extends previous research by exploring the predictive value of beliefs about insulin therapy in fear of hypoglycaemia (FoH). Data were collected on 81 Spanish adults (aged 18–58 years) with type 1 diabetes. Participants completed a survey questionnaire containing the following measures: state-trait anxiety inventory, beliefs about medicines questionnaire (specific scale), a modified version of the FoH Survey (worry scale) and different questions about demographic and clinical information (duration of diabetes, daily shots of insulin, severe hypoglycaemic episodes, metabolic control). Regression analyses showed that history of severe hypoglycaemic episodes and concerns about insulin therapy had the most predictive influence on FoH. Treatment perceptions, particularly concerns about insulin, were related to reported FoH. However, FoH is a complex phenomenon and more research is needed in order to gain a better understanding of its predictors and correlates.

Objectives: To evaluate the reach and effectiveness of a diabetes self-management DVD compared to classroom-based instruction.

Methods: A hybrid preference/randomized design was used with participants assigned to Choice v. Randomized and DVD v. Class conditions. One hundred and eighty-nine adults with type 2 diabetes participated. Key outcomes included self-management behaviours, process measures including DVD implementation and hypothesized mediators and clinical risk factors.

Results: In the Choice condition, four times as many participants chose the mailed DVD as selected Class-based instruction (38.8 v. 9.4%, p < 0.001). At the 6-month follow-up, the DVD produced results generally not significantly different than classroom-based instruction, but a combined Class plus DVD condition did not improve outcomes beyond those produced by the classes alone.

Discussion: The DVD appears to have merit as an efficient and appealing alternative to brief classroom-based diabetes education, and the hybrid design is recommended to provide estimates of programme reach.

Background: Previous studies in Jordan showed a considerably high prevalence of metabolic syndrome (MeS) and its individual components. However, data about the association between MeS and coronary artery disease (CAD) in Jordan are lacking. Therefore, this study aimed to determine the association between MeS and CAD among Jordanians.

Methods: This case-control study included 269 patients diagnosed with CAD and 1026 subjects without CAD. Data collected from cases and controls included socio-demographic and clinical characteristics and anthropometric measurements. Patients were diagnosed with MeS based on the criteria of the National Cholesterol Education Program (NCEP) adult treatment panel (ATP) III.

Results: MeS was present in 65.1% of patients with CAD and in 44.0% of those with no CAD (p < 0.0005). After adjusting for the important variables in the multivariate analysis, those with MeS were twice more likely to have CAD (OR = 1.94, 95% CI: 1.29, 2.93, p = 0.002) compared to those without MeS. The number of metabolic abnormalities was significantly associated with CAD, when it substituted MeS in the regression model, with a higher number of MeS components led to greater odds for CAD.

Conclusions: The MeS, which occurs very frequently in the general population, is associated with CAD in Jordan. The identification of subjects with the MeS is conceivably useful from a clinical standpoint, as it can be anticipated that these individuals should benefit from interventions aimed at reducing cardiovascular risk.