What Works in a Nurse Led Self-Management Program for Patients with Serious Mental Illness (SMI) and Diabetes (DM).

Objective: To develop a deeper understanding of "how" a nurse led self-management intervention in a successful randomized controlled trial (RCT) for individuals with both serious mental illness (SMI) and diabetes (DM) influenced health outcomes and the lives of the participants.

Methods: In depth interviews, were conducted with a sample of 10 participants who received the self-management intervention in the RCT. Interviews were audiotaped, transcribed verbatim, and analyzed using content analysis, with an emphasis on dominant themes.

Results: The mean age of the respondents was 53.9years (SD=5.6); 6 (60%) were women and the mean level of education was 12.4years (SD=2.4). Transcript based analysis generated 3 major mechanisms of action that led to improved self-management of their SMI and DM: (Colton & Manderscheid, 2006) positive group experience, (Osborn et al., 2008) increased health knowledge, and (Newcomer, 2005) increased self- confidence.

Conclusions: Developing complex interventions for testing in RCTs of individuals with SMI and other comorbid conditions is of increasing importance in healthcare planning for this vulnerable population. Using qualitative methods to explore mechanisms of action underlying quantitative outcomes, can enrich our understanding of processes relevant for individuals with SMI and comorbid conditions.