Predictors of Health Self-Management Program Preference Among Lower-to-Middle Wage Employed Adults With Chronic Health Conditions

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

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)172-182
Number of pages11
JournalAmerican Journal of Health Promotion
Issue number2
StatePublished - Feb 1 2019


  • chronic disease
  • financial strain
  • health disparities
  • self-management
  • symptom burden

ASJC Scopus subject areas

  • Health(social science)
  • Public Health, Environmental and Occupational Health


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