Results of a self-management program for non-communicable diseases in its face-to-face and online versions: a comparative study

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León Hernández, Isabel Peñarrieta Córdoba, Andrea Abigail Díaz Ramírez, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8041377/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 16 You are reading this latest preprint version Abstract This study compared the effectiveness of the Chronic Disease Self-Management Program delivered in face-to-face and online modalities for individuals with non-communicable diseases (NCDs), aiming to evaluate its impact on self-management and self-efficacy. A pre-experimental design with repeated measures (pretest, post-test, and three-month follow-up) was used in two independent groups (face-to-face n = 52, online n = 25), the Partners in Health Scale and the Self-Efficacy for the Management of Chronic Diseases instrument, both validated tools, were used. The results showed that although both groups started from similar conditions, the face-to-face modality produced statistically significant improvements in self-management and self-efficacy, which were sustained in the medium term, while the online modality did not show significant changes. These differences may be attributed to factors such as group interaction, technical support, and participants’ digital literacy. It is concluded that in-person training may yield better outcomes in self-management; however, findings should be interpreted with caution due to the small sample size. self-management self-efficacy chronic disease program evaluation effective-ness Figures Figure 1 Figure 2 Figure 3 Background Non-communicable diseases (NCDs) are a global public health problem, accounting for 70% of all deaths worldwide, equivalent to 41 million deaths annually ( 1 ). In Mexico, during the first half of 2023, NCDs were responsible for 7 of the 10 leading causes of death, with a total of 253,819 fatalities ( 2 ). This high disease burden has led to the need to implement effective and sustainable intervention strategies to address the issue. In this context, the World Health Organization (WHO) has emphasized the development of pro-grams for people with NCDs that promote behavioral changes aimed at preventing and controlling these conditions, as well as reducing their prevalence, the burden on health systems and the long-term effects on the health of those affected. The Chronic Disease Self-Management Program (CDSMP) developed by Stanford University has been shown to be an effective strategy for reducing health service utilization and improving the health behaviors of individuals with NCDs. It has been implemented in several countries such as China ( 3 ), Saudi Arabia ( 4 , 5 ), Singapore ( 6 ), Ireland ( 7 ), the United States ( 8 ), Spain, and Mexico ( 9 , 10 ), and has demonstrated significant improvements in behaviors related to disease management, including self-management ( 3 , 4 ) and self-efficacy ( 8 , 10 , 12 ). According to the WHO ( 12 ), self-management is the individual's ability to manage their health. It involves participation in achieving therapeutic goals, preparation to man-age their health condition on a day-to-day basis, practicing healthy behaviors, and devel-oping skills to reduce the impact of the disease—either independently or with the support of the healthcare team ( 13 ). On the other hand, self-efficacy is defined as the belief that a person has the capabilities to perform the necessary actions that allow them to obtain the desired outcomes ( 14 ). Moreover, it is an essential predictor for developing self-management, as self-efficacy influences motivation, behavioral change, and overall health outcomes ( 15 , 16 ). Unlike other interventions that focus solely on specific clinical or behavioral aspects, the CDSMP encourages participants to take an active role in their healthcare and informed decision-making. It also fosters collaboration with health professionals in areas such as pain and fatigue management, healthy eating, physical activity, and effective communication ( 8 , 9 ). Previous studies of the CDSMP have carried out evaluations with medium-term follow-ups, which have shown that changes in self-management behavior tend to be maintained or even improved. These outcomes are reflected in a greater knowledge of the disease, improved treatment adherence, and more effective management of the physical, emotional, and social impact ( 18 , 19 ). Scientific evidence has also demonstrated improvements in self-efficacy behavior ( 7 , 17 ), reflected in using techniques to deal with fatigue, improve nutrition, incorporate physical activity, make informed decisions, and strengthen health literacy ( 3 , 5 ). Likewise, improvements in self-management ( 3 , 6 – 8 , 10 , 17 ) and communication with the health team have been documented ( 11 ). These findings support the relevance of the CDSMP as an effective strategy for the management of NCDs. Currently, the CDSMP is delivered synchronously via videoconferencing, as an accessible alternative to provide support to people with chronic conditions. Its outcomes have shown improvements in physical activity, strength exercises, depression, self-efficacy, and use of health services, as well as a reduction in fatigue and pain ( 9 , 17 , 19 , 20 ). Likewise, other self-management programs have been implemented through digital platforms using an asynchronous format, allowing users to access educational and guided content virtually. These programs have demonstrated positive effects on adherence, self-efficacy, sleep, and increased physical activity ( 20 – 23 ). The available evidence suggests that online programs targeting individuals with NCDs are effective, as well as their face-to-face counterparts, in improving health behaviors ( 18 , 20 ). However, to date, no studies have specifically compared the program’s face-to-face and online formats. Therefore, this study aims to compare and evaluate the outcomes of the CDSMP in its face-to-face and online versions in the variables of self-management and self-efficacy among people with non-communicable diseases. Methods Participation and recruitment The design of this study was pre-experimental, with two independent groups (face-to-face and online) and repeated measures (pretest, post-test and 3-month follow-up). The initial non-probabilistic sample consisted of n = 77 participants with a non-communicable disease from the cities of Tampico (n = 64) and Monterrey (n = 13). Participants were recruited through a mixed sampling approach — by public call and institutional convenience — and were non-randomly assigned to one of the two implementation modalities of the CDSMP: four face-to-face groups (n = 52) and two online groups (n = 25). Participants who had been diagnosed with a non-communicable disease for more than 3 months at the time of the study were included in it. Individuals under 18 years of age and those who did not complete all assessment instruments were excluded. Loss to follow-up (3 months) decreased the total number of participants to n = 43 (face-to-face n = 28 and online n = 15). Figure 1 Process of Assignment and Follow-up of Participants in the CDSMP Modalities Measures The "Partner in Health Scale" instrument was used to measure self-management. This instrument consists of 12 rated on a visual numeric scale ranging from 0 to 8. His interpretation is: "The higher the score, the greater the self-management". The Mexican validation of the scale identified a structure composed of three dimensions: knowledge of the disease (items 1 and 2), treatment adherence (items 3, 4, 5, 6, 7, and 8), management of signs and symptoms (items 9, 10, 11 and 12). Cronbach's Alpha was 0.88 ( 24 ). The instrument "Self-efficacy for the management of chronic diseases" was used. It consists of 6 items rated on a visual numeric scale from 1 to 10. Scores are interpreted as such that higher values indicate greater self-efficacy. In Mexico, the instrument demonstrated strong internal consistency (Cronbach’s alpha = .927) and test-retest reliability (intraclass correlation coefficient = .813) ( 25 ). Data Collection Participants were recruited using two strategies. First, an open call was disseminated through the social networks Facebook and WhatsApp. Second, personal invitations were extended to school members from the Faculty of Nursing at the Autonomous University of Tamaulipas, Tampico campus, as well as to older adults affiliated with the organization Aging Healthy in Monterrey. Participants with NCDs were recruited by the two leaders assigned to each group, both of whom had been previously trained to implement the program. Each group consisted of between 10 and 14 participants. Once the groups were formed (4 in face-to-face format and 2 online), previously trained facilitators applied the instruments in their pretest measure. The CDSMP was then implemented, and at the end of the sessions, the post-test measure was used. The follow-up measure was carried out 3 months after the end of the program. The instruments were used in pencil and paper format in the face-to-face groups and through Google Forms for the groups in an online format. The CDSMP program comprises 6 sessions of 2.5 hours each, is applied once a week, and is led by 2 people trained and certified by Stanford University. The program content includes topics such as healthy eating, physical activity, decision-making, symptom management (including sleep, pain, and fatigue), emotional regulation, problem-solving, communication skills, and goal setting ( 26 ). This study is part of the larger project identified as CF-2023-G19349, which was ap-roved by the Research Ethics Committee of the Faculty of Nursing at the Autonomous University of Tamaulipas, Tampico campus, under registration number FET/CI/2023/002. The study followed the guidelines established in the Regulations of Mexico’s General Health Law on Health Research ( 27 ) and the Declaration of Helsinki ( 28 ). Statistical analysis Descriptive statistics were used to describe the characteristics of the study sample using frequencies, percentages, means, and standard deviations. The Kolmogorov-Smirnov test was applied to assess the normality of the data, and its significant results (p = < .05) justified the use of non-parametric inferential tests, including the Chi-square and Fisher's exact test, to com-pare sociodemographic variables between the implementation modalities of the CDSMP. To analyze the differences between groups (face-to-face and online), the Mann-Whitney U test was used. To compare repeated measures within each group (pretest, post-test, and follow-up), the Friedman test was performed. Results The mean age of participants in the face-to-face group was 50.10 years (SD = 16.49), while the mean age in the online group was 44.64 years (SD = 18.18), with no statistically significant difference (p = .182). As shown in Table 1 , the majority of participants in both groups were women. Cardiometabolic diseases were the most prevalent (hypertension and diabetes mellitus). Regarding marital status, married participants predominated in the face-to-face group, while single participants were more common in the online group. No statistically significant differences were found in sociodemographic characteristics (p > .05). Table 1 Sociodemographic characteristics of face-to-face and online groups Face to face Online f % f % Sig Sex Male 44 84.6 22 88 Fisher = .158 p = .492 Female 8 15.4 3 12 Marital Status Married/Common-law 30 57.7 9 36 X 2 = 5.30 p = .151 Divorced 5 9.6 1 4 Single 15 28.8 13 52 Widower 2 3.8 2 8 First NCDs reported Hypertension/cardiovascular problems 22 42.3 6 24 X 2 = 5.30 p = .195 Diabetes 10 19.2 7 28 Obesity 3 5.8 2 8 Mental health 4 7.7 2 8 Gastrointestinal disease 2 3.8 3 12 Other 11 21.1 5 20 To address the study objective, the results of the CDSMP implementation between its face-to-face and online formats were initially compared across three measurement points (pretest, posttest, and follow-up). The results indicate equality between the groups at the beginning of the intervention (p > .05) in the variables self-efficacy and total self-management, as well as in their 3 dimensions: 1) knowledge, 2) adherence, and 3) management of signs and symptoms. In the post-test measurement, differences were observed between groups in self-efficacy and in the self-management dimensions of knowledge and management of signs and symptoms. At the three-month follow-up, the face-to-face and online modalities also showed differences in self-efficacy, total self-management, and the adherence dimension, as summarized in Table 2 . Table 2 Comparison between face-to-face and online format of the CDSMP Variables CDSMP Face to face CDSMP Online Average Range Rank Sum Average Range Rank Sum Mann Whitney (Sig) Pretest Self- Efficacy 41.97 2182 32.82 820 495.5 (.093) Self-management 41.39 2152 34.02 850 525.5 (.175) Knowledge 40.18 2089 36.54 913 588.5 (.497) Adherence 41.35 2150 34.12 853 528 (.183) Signs and Symptoms 41.20 2142 34.42 860 535.5 (.212) Posttest Self- Efficacy 33.79 1351 23.93 478 268.5 (.039) Self-management 33.53 1341 24.45 489 279 (.057) Knowledge 34.75 1390 22 440 230 (.007) Adherence 32.03 1281 27.45 549 339 (.337) Signs and Symptoms 34.93 1397 21.65 433 223 (.005) Three-month follow-up Self- Efficacy 25.88 724 14.77 221 101.5 (.006) Self-management 25.02 700 16.37 245 125.5 (.031) Knowledge 23.84 667 18.57 278 158.5 (.177) Adherence 25.29 708 15.87 238 118 (.019) Signs and Symptoms 24.55 687 17.23 258 138.5 (.067) To evaluate the results of the CDSMP by delivery format (face-to-face and online), a repeated-measures analysis was conducted at three assessment points: pretest, posttest, and three-month follow-up. As shown in Table 3 , the face-to-face implementation produced statistically significant improvements in total self-management and in the dimensions of knowledge, adherence, and management of signs and symptoms, whereas self-efficacy did not show significant changes over time. Table 3 Results of the CDSMP Face-to-Face Variables Face-to-face Pretest Postest Three-month follow-up p Self- Efficacy 1.73 2.14 2.13 .212 Self-management 1.39 2.32 2.29 .000 Knowledge 1.64 2.07 2.29 .027 Adherence 1.54 2.13 2.34 .004 Signs and Symptoms 1.55 2.23 2.21 .009 The results of the CDSMP program in its online format did not show statistically sig-nificant differences at the three-month follow-up (3 months), in the variables of self-efficacy and self-management, including their dimensions (knowledge, adherence and management of signs and symptoms). Although slight improvements were observed in some scores, these changes were not significant (see Table 4 ). Table 4 Results of the CDSMP Face-to-Face Variables Online Pretest Postest Three-month follow-up p Self- Efficacy 1.87 2.07 2.07 .813 Self-management 1.77 2.03 2.20 .482 Knowledge 1.93 1.67 2.40 .084 Adherence 1.83 2.07 2.10 .721 Signs and Symptoms 1.83 1.93 2.23 .498 To illustrate the direction of the changes observed in the study variables after the implementation of the CDSMP, graphs were created using the median values of each variable. In the face-to-face format, improvements were observed in all analyzed variables, including self-efficacy, overall self-management, and its dimensions, from pretest to posttest. In most cases, this positive trend was maintained or even increased in the three-month follow-up measurement. The only exception is the self-efficacy, which showed a slight decrease at follow-up, although it remained above the pretest (see graph 1). Regarding the online format, most of the evaluated variables also showed improvements from the pretest to the posttest. In particular, improvements in the knowledge and management of signs and symptoms dimensions were maintained at the three-month follow-up after the program was delivered. In contrast, the variables self-efficacy, total self-management, and adherence dimension showed a decrease in their values at follow-up (see graph 2). Discussion The aim of this study was to compare and evaluate the outcomes of the CDSMP, delivered in face-to-face and online formats, focusing on the variables of self-management and self-efficacy in people with non-communicable diseases. When comparing both groups at pretest, as expected, no significant differences were found in the research variables, which indicates equivalent initial conditions among the participants. However, in the posttest and three-month follow-up assessments, some differences can be attributed to the format in which the program was implemented. The post-test results showed statistically significant differences in self-efficacy, total self-management, and the dimensions of knowledge and management of signs and symptoms. These differences were sustained at follow-up in the variables of self-efficacy and total self-management. Additionally, the adherence dimension showed significant differences at the three-month follow-up. Based on these findings, the face-to-face and online versions of the CDSMP produce different results in the variables studied. The intragroup analysis was essential to clarify the differences in the outcomes between the two modalities. When analyzed independently, the evaluation of the face-to-face ver-sion of the program showed statistically significant improvements in overall self-management and its dimensions: knowledge, adherence, and management of signs and symptoms (see Table 3 ). The direction of these changes was positive and remained consistent over three months. In the case of the adherence dimension, it showed an increasing trend over time, which suggests a progressive strengthening of the acquired behaviors (see Graph 1). These findings are consistent with previous studies on the face-to-face version of the CDSMP, which have reported positive effects on self-management behaviors ( 3 , 5 , 17 ) and self-efficacy ( 4 , 6 , 7 , 18 ), as well as reductions in pain ( 3 , 5 ) and depressive symptoms in the medium and long term, among participants. In contrast, the results of the CDSMP in the virtual format did not show statistically significant effects on any of the study's variables in the medium term (see Table 4 ). Although no significant changes were observed, it is important to highlight that self-efficacy, total self-management, and the adherence dimension showed a slight increase in their median values at the end of the intervention (posttest). However, by the three-month follow-up, these variables had declined, indicating that the initial positive effects were not sustained over time (see Fig. 2 ). These findings differ from those reported by Lorig et al. ( 19 ) and León Hernández et al. ( 9 ), who demonstrated significant medium-term effects of the CDSMP in the online format, particularly in self-efficacy and health behaviors such as increased physical activity, as well as reductions in emotional variables such as depression. This discrepancy may be explained by the sample sizes used in the different studies and also highlights one of the limitations of the present study: small samples. It is essential to add that the other online programs targeting people with chronic conditions offer a flexible alternative, as they allow participants to access educational and support resources from anywhere, with greater adaptability to their schedules ( 9 , 23 , 29 , 30 ). In addition, these formats can expand program reach by enabling more people to participate according to their preferences. ( 21 ). However, several studies have pointed out that the success of online pro-grams depends not only on the design and guidance provided by the programs and healthcare teams, but also on the participants’ digital skills and experience ( 19 , 21 , 22 , 30 ). Furthermore, factors such as access to electronic devices, internet connectivity, the partici-pant's autonomy level, and the technical support they receive during the process may in-fluence the program's success ( 31 ). On the other hand, Marier-Deschenes et al. ( 30 ) showed that people with chronic illnesses who participated in an online program had difficulties connecting to the sessions due to external factors and technological barriers, which negatively impacted their adherence to the program. However, it is essential to recognize that the effectiveness of online programs depends not only on participants' individual abilities in a virtual environment but also on the preparedness of health systems to facilitate their implementation. In line with several authors, it has been suggested that online programs require more robust, accessible, and culturally adaptable structures capable of accommodating diverse lifestyles and individual preferences ( 19 , 23 , 32 ). The present study suggests that although the CDSMP in its face-to-face modality showed favorable results for its participants in their self-management and self-efficacy behaviors, its online version did not achieve significant effects. This disparity underscores the importance of considering key factors that may influence program effectiveness in digital formats, such as internet connectivity, access to electronic devices, and the level of technical support provided throughout the process. Addressing these conditions is essential to ensure that participants benefit equally, regardless of the modality. In this regard, digital programs should incorporate digital inclusion strategies and provide ongoing support to both participants and facilitators to ensure a more equitable, effective, and needs-focused implementation. Likewise, some key program components, such as action plans and problem-solving techniques, have been identified in previous studies as effective strategies to promote self-management and enhance participants' self-efficacy ( 4 , 5 ). When implemented in a group setting, these elements allow participants to share successes and challenges, fostering a supportive social environment that encourages the adoption of healthy behaviors ( 7 ). The group dynamics of the program not only facilitate the exchange of experiences but also contribute to participants’ engagement and commitment, an outcome especially pro-nounced in the face-to-face format. Consistent with the results obtained in this study, it can be inferred that a fundamental part of the program is based on Bandura’s Social Learning Theory and its self-efficacy component, which recognizes the influence of group members in modifying each other's behavior through modeling, personal experiences, and learned responses ( 14 ). In this regard, the face-to-face format promotes greater group interaction, allowing participants to engage more actively with peers and facilitators, thereby fostering a stronger sense of commitment to the learning process. In contrast, the virtual format presents a lower degree of interaction, which could make it difficult for participants to relate solidly with their peers or facilitators. This limitation could negatively affect motivation, attention, adherence ( 22 , 23 , 31 ), and overall commitment to the program ( 30 ). Conclusions Based on the results, it can be concluded that participants who received the CDSMP program in the face-to-face modality demonstrated significant improvements in self-management and its dimensions (knowledge, adherence, and management of signs and symptoms) both in the short and medium term. In contrast, participants enrolled in online modality did not show statistically significant improvements. Although both delivery formats share the objective of fostering active health self-management, the results suggest that face-to-face modality more effectively promotes these behaviors. This can be explained by the influence of the social component through vicarious learning, modeling, and self-efficacy, components of Bandura's social learning theory, which appear to be more strongly activated in in-person settings. Therefore, it is suggested that, in order to ensure equity in the benefits of the program, it is necessary to strengthen the online implementation with technological and support strategies that encourage active participation, consolidation, and collective learning. Finally, the apparent advantage of the face-to-face modality should be interpreted with caution due to several limitations: the overall sample size, the unequal number of participants between modalities, the non-random assignment to groups, differences in instrument administration formats (paper-and-pencil vs. Google Forms), and attrition at follow-up. Future research should include larger probabilistic samples, randomized group assignment, and standardized procedures for instrument administration to minimize potential sources of bias. Declarations Ethics approval and consent to participate It has been ethically approved by the Research Ethics Committee of the Faculty of Nursing at the Autonomous University of Tamaulipas, Tampico campus, under registration number FET/CI/2023/002. Informed written consent was collected from all participants in the current study. The study followed the guidelines established in the Regulations of Mexico’s General Health Law on Health Research and the Declaration of Helsinki. Consent for publication Not Applicable Competing interests The authors declare no conflicts of interest. The sponsors had no role in the design of the study; in the collection, analysis, or interpretation of data; in the writing of the manu-script; or in the decision to publish the results Funding The authors are grateful to the Secretariat of Science, Humanities, Technology, and Innovation for funding project CF-2023-G-1394, titled "Self-management strategies to im-prove the health of people with chronic diseases and family caregivers. A Network-Based Approach”, from which this manuscript is derived. Author Contribution Conceptualization IPC and AADR.; methodology RCLH and EBMH, formal analysis, RCLH., JLAM; data curation, L.M.Q.V; writing—original draft preparation RCLH, AADR, EBMH; writing—review and editing, JLAM, IPC, TGG. All authors have read and agreed to the published version of the manuscript. Acknowledgement The authors gratefully acknowledge the voluntary participation of people with non-communicable diseases (NCDs) in this study. 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Talk to Your Doctors Online: An Internet-based Intervention in China. Health Commun. 2021;36(4):405–11. Peñarrieta-de Córdova I, Barrios FF, Gutierrez-Gomes T, Piñonez-Martinez M, del Quintero-Valle S, Castañeda-Hidalgo LM. H. Self-management in chronic conditions: partners in health scale instrument validation. Nurs Manag (Harrow) [Internet]. 2014 [cited 2025 Jun 16];20(10):32–7. Available from: https://pubmed.ncbi.nlm.nih.gov/24571163/ Rodrigo Cesar León Hernández. María Isabel Peñarrieta de Córdova, Tranquilina Gutiérrez Gómez. Capítulo V. Validación de instrumentos de indicadores de salud y psicosociales. Red de automanejo de enfermedades crónicas. In: Gutiérrez Gómez Tranquilina, Castañeda Hidalgo Hortensia, editors. Estrategias de aprendizaje en cronicidad [Internet]. Ciudad Victoria: colofón; 2020 [cited 2025 Jun 22]. pp. 69–89. Available from: https://cdn.prod.websitefiles.com/661d6332a1299c20c570d453/662aa79c4ff2a67b654eab1b_1.-capitulo-5-validaci%C3%B3n-de-instrumentos2.pdf#page=14.37 Gonzales V, Lorig K, Laurent D, Castagnola L. Taller Virtual Tomando Control de su Salud. Manual para líderes. Self-Management Resource Center; 2021. Cámara de Diputados del H. Congreso de la Unión. Reglamento de la Ley General de Salud en Materia de Investigación para la Salud. Diario Oficial de la Federación [D.O.F.], Última Reforma DOF 02-04-2014 México: https://www.diputados.gob.mx/LeyesBiblio/regley/Reg_LGS_MIS.pdf ; 2014. Asociación Médica Mundial. Declaración de Helsinki de la AMM – Principios éticos para las investigaciones médicas en seres humanos [Internet]. 2015 [cited 2024 Jun 9]. Available from: https://www.wma.net/es/policies-post/declaracion-de-helsinki-de-la-amm-principios-eticos-para-las-investigaciones-medicas-en-seres-humanos/ Drieling RL, Ma J, Thiyagarajan S, Stafford RS. An internet-based osteoporotic frac-ture risk program: Effect on knowledge, attitudes, and behaviors. J Womens Health. 2011;20(12):1895–907. Marier-Deschenes PP, anne MJLLA. Assessing the Feasibility and Preliminary Effects of a WebBased Self-Management Program for Chronic Noncancer Pain. Mixed Methods Study. 2024;11. Wu Y, Wen J, Wang X, Wang Q, Wang W, Wang X et al. Associations between e-health literacy and chronic disease self-management in older Chinese patients with chronic non-communicable diseases: a mediation analysis. BMC Public Health. 2022;22(1). Kerari A, Bahari G, Alharbi K, Alenazi L. The Effectiveness of the Chronic Disease Self-Management Program in Improving Patients’ Self-Efficacy and Health-Related Be-haviors: A Quasi-Experimental Study. Healthcare 2024, Vol 12, Page 778 [Internet]. 2024 Apr 3 [cited 2025 Jun 11];12(7):778. Available from: https://www.mdpi.com/2227-9032/12/7/778/htm Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 13 Apr, 2026 Reviews received at journal 13 Apr, 2026 Reviews received at journal 07 Apr, 2026 Reviewers agreed at journal 06 Apr, 2026 Reviewers agreed at journal 02 Apr, 2026 Reviews received at journal 31 Mar, 2026 Reviewers agreed at journal 28 Mar, 2026 Reviewers agreed at journal 26 Mar, 2026 Reviewers agreed at journal 10 Jan, 2026 Reviewers agreed at journal 10 Jan, 2026 Reviewers agreed at journal 09 Jan, 2026 Reviewers invited by journal 08 Jan, 2026 Editor invited by journal 26 Dec, 2025 Editor assigned by journal 26 Nov, 2025 Submission checks completed at journal 24 Nov, 2025 First submitted to journal 24 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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León","lastName":"Hernández","suffix":""},{"id":572390635,"identity":"7839925a-9b3f-439e-9c0c-521c883f8b42","order_by":1,"name":"Isabel Peñarrieta Córdoba","email":"","orcid":"","institution":"Universidad Autónoma de Tamaulipas","correspondingAuthor":false,"prefix":"","firstName":"Isabel","middleName":"Peñarrieta","lastName":"Córdoba","suffix":""},{"id":572390636,"identity":"39a74964-5f7f-4897-8898-c6d303bbefde","order_by":2,"name":"Andrea Abigail Díaz Ramírez","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYHACgwMMDDYQJg8JWtIYGNhI0QLEh0nQwt9+eOOBH3/OJ/bPb2B88LaNIRpkKV4gcSat4GAPz+3EGccYmA3ntjHkzmwgZM2BHIMDPBK3ExuOMbBJ8wK19BPSIX/+jcHBPwbnEucfY2D/DdLSRkiLwY0cg8M8CQcSNwBtYSbKFsMbzwoOyxxINt54LLFZcs45CcJ+kTufvPnjmz92svMOHz744U2ZTe6GA4SsQQBGkPESxKsfBaNgFIyCUYAbAADgdEUi6wutWwAAAABJRU5ErkJggg==","orcid":"","institution":"Universidad Autónoma de 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09:09:50","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":43804,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8041377/v1/510d52c0149052e7e053df90.png"},{"id":100124104,"identity":"5f1a4c71-688d-4c21-83fb-25df2299930a","added_by":"auto","created_at":"2026-01-13 09:09:52","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":103540,"visible":true,"origin":"","legend":"","description":"","filename":"d2b59210d1304b08bc94d2179658c2801structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8041377/v1/565676301eb39a0609394825.xml"},{"id":100124092,"identity":"da61e59f-d14c-49f1-a8ba-c8a5aefe7e65","added_by":"auto","created_at":"2026-01-13 09:09:51","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":116348,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8041377/v1/e51135798795d66be1dd7b46.html"},{"id":100124101,"identity":"02cd5168-d78d-4180-a07e-5a8dcb77d5be","added_by":"auto","created_at":"2026-01-13 09:09:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":44230,"visible":true,"origin":"","legend":"\u003cp\u003eProcess of Assignment and Follow-up of Participants in the CDSMP Modalities\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8041377/v1/37d5f6d25dc442679759dda4.png"},{"id":100124097,"identity":"51104608-54ae-4529-a2da-56e794b34b3b","added_by":"auto","created_at":"2026-01-13 09:09:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":82149,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 1\u003c/strong\u003e. Results of the CDSMP Face-to-face\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8041377/v1/f6328f4b1a6763d62945443e.png"},{"id":100124108,"identity":"3ba49db3-3161-46ca-a23d-971a294f45b8","added_by":"auto","created_at":"2026-01-13 09:09:53","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":72699,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 2\u003c/strong\u003e. Results of the CDSMP Online\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8041377/v1/046b89a54e0d479d2a9a7e6b.png"},{"id":100124157,"identity":"1c2351c1-9e2d-434a-87f6-1e24e357555e","added_by":"auto","created_at":"2026-01-13 09:10:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":982827,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8041377/v1/1b8d8c98-9555-48b7-b497-eea51ce9917d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Results of a self-management program for non-communicable diseases in its face-to-face and online versions: a comparative study","fulltext":[{"header":"Background","content":"\u003cp\u003eNon-communicable diseases (NCDs) are a global public health problem, accounting for 70% of all deaths worldwide, equivalent to 41\u0026nbsp;million deaths annually (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In Mexico, during the first half of 2023, NCDs were responsible for 7 of the 10 leading causes of death, with a total of 253,819 fatalities (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This high disease burden has led to the need to implement effective and sustainable intervention strategies to address the issue. In this context, the World Health Organization (WHO) has emphasized the development of pro-grams for people with NCDs that promote behavioral changes aimed at preventing and controlling these conditions, as well as reducing their prevalence, the burden on health systems and the long-term effects on the health of those affected.\u003c/p\u003e \u003cp\u003eThe Chronic Disease Self-Management Program (CDSMP) developed by Stanford University has been shown to be an effective strategy for reducing health service utilization and improving the health behaviors of individuals with NCDs. It has been implemented in several countries such as China (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), Saudi Arabia (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), Singapore (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), Ireland (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), the United States (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), Spain, and Mexico (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), and has demonstrated significant improvements in behaviors related to disease management, including self-management (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) and self-efficacy (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to the WHO (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), self-management is the individual's ability to manage their health. It involves participation in achieving therapeutic goals, preparation to man-age their health condition on a day-to-day basis, practicing healthy behaviors, and devel-oping skills to reduce the impact of the disease\u0026mdash;either independently or with the support of the healthcare team (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). On the other hand, self-efficacy is defined as the belief that a person has the capabilities to perform the necessary actions that allow them to obtain the desired outcomes (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Moreover, it is an essential predictor for developing self-management, as self-efficacy influences motivation, behavioral change, and overall health outcomes (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Unlike other interventions that focus solely on specific clinical or behavioral aspects, the CDSMP encourages participants to take an active role in their healthcare and informed decision-making. It also fosters collaboration with health professionals in areas such as pain and fatigue management, healthy eating, physical activity, and effective communication (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePrevious studies of the CDSMP have carried out evaluations with medium-term follow-ups, which have shown that changes in self-management behavior tend to be maintained or even improved. These outcomes are reflected in a greater knowledge of the disease, improved treatment adherence, and more effective management of the physical, emotional, and social impact (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Scientific evidence has also demonstrated improvements in self-efficacy behavior (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), reflected in using techniques to deal with fatigue, improve nutrition, incorporate physical activity, make informed decisions, and strengthen health literacy (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Likewise, improvements in self-management (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) and communication with the health team have been documented (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). These findings support the relevance of the CDSMP as an effective strategy for the management of NCDs.\u003c/p\u003e \u003cp\u003eCurrently, the CDSMP is delivered synchronously via videoconferencing, as an accessible alternative to provide support to people with chronic conditions. Its outcomes have shown improvements in physical activity, strength exercises, depression, self-efficacy, and use of health services, as well as a reduction in fatigue and pain (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLikewise, other self-management programs have been implemented through digital platforms using an asynchronous format, allowing users to access educational and guided content virtually. These programs have demonstrated positive effects on adherence, self-efficacy, sleep, and increased physical activity (\u003cspan additionalcitationids=\"CR21 CR22\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe available evidence suggests that online programs targeting individuals with NCDs are effective, as well as their face-to-face counterparts, in improving health behaviors (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). However, to date, no studies have specifically compared the program\u0026rsquo;s face-to-face and online formats. Therefore, this study aims to compare and evaluate the outcomes of the CDSMP in its face-to-face and online versions in the variables of self-management and self-efficacy among people with non-communicable diseases.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipation and recruitment\u003c/h2\u003e \u003cp\u003eThe design of this study was pre-experimental, with two independent groups (face-to-face and online) and repeated measures (pretest, post-test and 3-month follow-up). The initial non-probabilistic sample consisted of n\u0026thinsp;=\u0026thinsp;77 participants with a non-communicable disease from the cities of Tampico (n\u0026thinsp;=\u0026thinsp;64) and Monterrey (n\u0026thinsp;=\u0026thinsp;13). Participants were recruited through a mixed sampling approach \u0026mdash; by public call and institutional convenience \u0026mdash; and were non-randomly assigned to one of the two implementation modalities of the CDSMP: four face-to-face groups (n\u0026thinsp;=\u0026thinsp;52) and two online groups (n\u0026thinsp;=\u0026thinsp;25).\u003c/p\u003e \u003cp\u003eParticipants who had been diagnosed with a non-communicable disease for more than 3 months at the time of the study were included in it. Individuals under 18 years of age and those who did not complete all assessment instruments were excluded. Loss to follow-up (3 months) decreased the total number of participants to n\u0026thinsp;=\u0026thinsp;43 (face-to-face n\u0026thinsp;=\u0026thinsp;28 and online n\u0026thinsp;=\u0026thinsp;15).\u003c/p\u003e \u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e Process of Assignment and Follow-up of Participants in the CDSMP Modalities\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eThe \"Partner in Health Scale\" instrument was used to measure self-management. This instrument consists of 12 rated on a visual numeric scale ranging from 0 to 8. His interpretation is: \"The higher the score, the greater the self-management\". The Mexican validation of the scale identified a structure composed of three dimensions: knowledge of the disease (items 1 and 2), treatment adherence (items 3, 4, 5, 6, 7, and 8), management of signs and symptoms (items 9, 10, 11 and 12). Cronbach's Alpha was 0.88 (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe instrument \"Self-efficacy for the management of chronic diseases\" was used. It consists of 6 items rated on a visual numeric scale from 1 to 10. Scores are interpreted as such that higher values indicate greater self-efficacy. In Mexico, the instrument demonstrated strong internal consistency (Cronbach\u0026rsquo;s alpha\u0026thinsp;=\u0026thinsp;.927) and test-retest reliability (intraclass correlation coefficient\u0026thinsp;=\u0026thinsp;.813) (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eParticipants were recruited using two strategies. First, an open call was disseminated through the social networks Facebook and WhatsApp. Second, personal invitations were extended to school members from the Faculty of Nursing at the Autonomous University of Tamaulipas, Tampico campus, as well as to older adults affiliated with the organization Aging Healthy in Monterrey. Participants with NCDs were recruited by the two leaders assigned to each group, both of whom had been previously trained to implement the program. Each group consisted of between 10 and 14 participants.\u003c/p\u003e \u003cp\u003eOnce the groups were formed (4 in face-to-face format and 2 online), previously trained facilitators applied the instruments in their pretest measure. The CDSMP was then implemented, and at the end of the sessions, the post-test measure was used. The follow-up measure was carried out 3 months after the end of the program. The instruments were used in pencil and paper format in the face-to-face groups and through Google Forms for the groups in an online format. The CDSMP program comprises 6 sessions of 2.5 hours each, is applied once a week, and is led by 2 people trained and certified by Stanford University. The program content includes topics such as healthy eating, physical activity, decision-making, symptom management (including sleep, pain, and fatigue), emotional regulation, problem-solving, communication skills, and goal setting (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e This study is part of the larger project identified as CF-2023-G19349, which was ap-roved by the Research Ethics Committee of the Faculty of Nursing at the Autonomous University of Tamaulipas, Tampico campus, under registration number FET/CI/2023/002. The study followed the guidelines established in the Regulations of Mexico\u0026rsquo;s General Health Law on Health Research (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) and the Declaration of Helsinki (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were used to describe the characteristics of the study sample using frequencies, percentages, means, and standard deviations. The Kolmogorov-Smirnov test was applied to assess the normality of the data, and its significant results (p\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;.05) justified the use of non-parametric inferential tests, including the Chi-square and Fisher's exact test, to com-pare sociodemographic variables between the implementation modalities of the CDSMP. To analyze the differences between groups (face-to-face and online), the Mann-Whitney U test was used. To compare repeated measures within each group (pretest, post-test, and follow-up), the Friedman test was performed.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean age of participants in the face-to-face group was 50.10 years (SD\u0026thinsp;=\u0026thinsp;16.49), while the mean age in the online group was 44.64 years (SD\u0026thinsp;=\u0026thinsp;18.18), with no statistically significant difference (p\u0026thinsp;=\u0026thinsp;.182). As shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the majority of participants in both groups were women. Cardiometabolic diseases were the most prevalent (hypertension and diabetes mellitus). Regarding marital status, married participants predominated in the face-to-face group, while single participants were more common in the online group. No statistically significant differences were found in sociodemographic characteristics (p\u0026thinsp;\u0026gt;\u0026thinsp;.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of face-to-face and online groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFace to face\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eOnline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ef\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003ef\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eSig\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eFisher\u003c/b\u003e\u0026thinsp;=\u0026thinsp;.158\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;.492\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried/Common-law\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eX\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;5.30\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u0026thinsp;=\u0026thinsp;.151\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst NCDs reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension/cardiovascular problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eX\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;5.30\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.195\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMental health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGastrointestinal disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTo address the study objective, the results of the CDSMP implementation between its face-to-face and online formats were initially compared across three measurement points (pretest, posttest, and follow-up). The results indicate equality between the groups at the beginning of the intervention (p\u0026thinsp;\u0026gt;\u0026thinsp;.05) in the variables self-efficacy and total self-management, as well as in their 3 dimensions: 1) knowledge, 2) adherence, and 3) management of signs and symptoms.\u003c/p\u003e \u003cp\u003eIn the post-test measurement, differences were observed between groups in self-efficacy and in the self-management dimensions of knowledge and management of signs and symptoms. At the three-month follow-up, the face-to-face and online modalities also showed differences in self-efficacy, total self-management, and the adherence dimension, as summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison between face-to-face and online format of the CDSMP\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCDSMP\u003c/p\u003e \u003cp\u003eFace to face\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eCDSMP\u003c/p\u003e \u003cp\u003eOnline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage Range\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRank Sum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAverage Range\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRank Sum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMann Whitney\u003c/p\u003e \u003cp\u003e(Sig)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePretest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf- Efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e820\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e495.5 (.093)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e850\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e525.5 (.175)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e913\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e588.5 (.497)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdherence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e853\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e528\u003c/p\u003e \u003cp\u003e(.183)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSigns and Symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e860\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e535.5 (.212)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosttest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf- Efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e478\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e268.5 (.039)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1341\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e489\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e279\u003c/p\u003e \u003cp\u003e(.057)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e440\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e230\u003c/p\u003e \u003cp\u003e(.007)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdherence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1281\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e549\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e339\u003c/p\u003e \u003cp\u003e(.337)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSigns and Symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1397\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e433\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e223\u003c/p\u003e \u003cp\u003e(.005)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eThree-month follow-up\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf- Efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e101.5 (.006)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e125.5 (.031)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e667\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e158.5 (.177)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdherence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e118\u003c/p\u003e \u003cp\u003e(.019)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSigns and Symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e687\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e138.5 (.067)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTo evaluate the results of the CDSMP by delivery format (face-to-face and online), a repeated-measures analysis was conducted at three assessment points: pretest, posttest, and three-month follow-up. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the face-to-face implementation produced statistically significant improvements in total self-management and in the dimensions of knowledge, adherence, and management of signs and symptoms, whereas self-efficacy did not show significant changes over time.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of the CDSMP Face-to-Face\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eFace-to-face\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePretest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePostest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThree-month follow-up\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf- Efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.212\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdherence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSigns and Symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results of the CDSMP program in its online format did not show statistically sig-nificant differences at the three-month follow-up (3 months), in the variables of self-efficacy and self-management, including their dimensions (knowledge, adherence and management of signs and symptoms). Although slight improvements were observed in some scores, these changes were not significant (see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of the CDSMP Face-to-Face\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eOnline\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePretest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePostest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThree-month follow-up\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf- Efficacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.813\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.482\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.084\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdherence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.721\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSigns and Symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.498\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTo illustrate the direction of the changes observed in the study variables after the implementation of the CDSMP, graphs were created using the median values of each variable. In the face-to-face format, improvements were observed in all analyzed variables, including self-efficacy, overall self-management, and its dimensions, from pretest to posttest. In most cases, this positive trend was maintained or even increased in the three-month follow-up measurement. The only exception is the self-efficacy, which showed a slight decrease at follow-up, although it remained above the pretest (see graph 1).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eRegarding the online format, most of the evaluated variables also showed improvements from the pretest to the posttest. In particular, improvements in the knowledge and management of signs and symptoms dimensions were maintained at the three-month follow-up after the program was delivered. In contrast, the variables self-efficacy, total self-management, and adherence dimension showed a decrease in their values at follow-up (see graph 2).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aim of this study was to compare and evaluate the outcomes of the CDSMP, delivered in face-to-face and online formats, focusing on the variables of self-management and self-efficacy in people with non-communicable diseases. When comparing both groups at pretest, as expected, no significant differences were found in the research variables, which indicates equivalent initial conditions among the participants. However, in the posttest and three-month follow-up assessments, some differences can be attributed to the format in which the program was implemented. The post-test results showed statistically significant differences in self-efficacy, total self-management, and the dimensions of knowledge and management of signs and symptoms. These differences were sustained at follow-up in the variables of self-efficacy and total self-management. Additionally, the adherence dimension showed significant differences at the three-month follow-up. Based on these findings, the face-to-face and online versions of the CDSMP produce different results in the variables studied.\u003c/p\u003e \u003cp\u003eThe intragroup analysis was essential to clarify the differences in the outcomes between the two modalities. When analyzed independently, the evaluation of the face-to-face ver-sion of the program showed statistically significant improvements in overall self-management and its dimensions: knowledge, adherence, and management of signs and symptoms (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The direction of these changes was positive and remained consistent over three months. In the case of the adherence dimension, it showed an increasing trend over time, which suggests a progressive strengthening of the acquired behaviors (see Graph 1). These findings are consistent with previous studies on the face-to-face version of the CDSMP, which have reported positive effects on self-management behaviors (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) and self-efficacy (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), as well as reductions in pain (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) and depressive symptoms in the medium and long term, among participants. In contrast, the results of the CDSMP in the virtual format did not show statistically significant effects on any of the study's variables in the medium term (see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough no significant changes were observed, it is important to highlight that self-efficacy, total self-management, and the adherence dimension showed a slight increase in their median values at the end of the intervention (posttest). However, by the three-month follow-up, these variables had declined, indicating that the initial positive effects were not sustained over time (see Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). These findings differ from those reported by Lorig et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) and Le\u0026oacute;n Hern\u0026aacute;ndez et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), who demonstrated significant medium-term effects of the CDSMP in the online format, particularly in self-efficacy and health behaviors such as increased physical activity, as well as reductions in emotional variables such as depression.\u003c/p\u003e \u003cp\u003eThis discrepancy may be explained by the sample sizes used in the different studies and also highlights one of the limitations of the present study: small samples. It is essential to add that the other online programs targeting people with chronic conditions offer a flexible alternative, as they allow participants to access educational and support resources from anywhere, with greater adaptability to their schedules (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). In addition, these formats can expand program reach by enabling more people to participate according to their preferences. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). However, several studies have pointed out that the success of online pro-grams depends not only on the design and guidance provided by the programs and healthcare teams, but also on the participants\u0026rsquo; digital skills and experience (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Furthermore, factors such as access to electronic devices, internet connectivity, the partici-pant's autonomy level, and the technical support they receive during the process may in-fluence the program's success (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOn the other hand, Marier-Deschenes et al. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) showed that people with chronic illnesses who participated in an online program had difficulties connecting to the sessions due to external factors and technological barriers, which negatively impacted their adherence to the program. However, it is essential to recognize that the effectiveness of online programs depends not only on participants' individual abilities in a virtual environment but also on the preparedness of health systems to facilitate their implementation. In line with several authors, it has been suggested that online programs require more robust, accessible, and culturally adaptable structures capable of accommodating diverse lifestyles and individual preferences (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe present study suggests that although the CDSMP in its face-to-face modality showed favorable results for its participants in their self-management and self-efficacy behaviors, its online version did not achieve significant effects. This disparity underscores the importance of considering key factors that may influence program effectiveness in digital formats, such as internet connectivity, access to electronic devices, and the level of technical support provided throughout the process. Addressing these conditions is essential to ensure that participants benefit equally, regardless of the modality. In this regard, digital programs should incorporate digital inclusion strategies and provide ongoing support to both participants and facilitators to ensure a more equitable, effective, and needs-focused implementation.\u003c/p\u003e \u003cp\u003eLikewise, some key program components, such as action plans and problem-solving techniques, have been identified in previous studies as effective strategies to promote self-management and enhance participants' self-efficacy (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). When implemented in a group setting, these elements allow participants to share successes and challenges, fostering a supportive social environment that encourages the adoption of healthy behaviors (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The group dynamics of the program not only facilitate the exchange of experiences but also contribute to participants\u0026rsquo; engagement and commitment, an outcome especially pro-nounced in the face-to-face format.\u003c/p\u003e \u003cp\u003eConsistent with the results obtained in this study, it can be inferred that a fundamental part of the program is based on Bandura\u0026rsquo;s Social Learning Theory and its self-efficacy component, which recognizes the influence of group members in modifying each other's behavior through modeling, personal experiences, and learned responses (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In this regard, the face-to-face format promotes greater group interaction, allowing participants to engage more actively with peers and facilitators, thereby fostering a stronger sense of commitment to the learning process. In contrast, the virtual format presents a lower degree of interaction, which could make it difficult for participants to relate solidly with their peers or facilitators. This limitation could negatively affect motivation, attention, adherence (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), and overall commitment to the program (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eBased on the results, it can be concluded that participants who received the CDSMP program in the face-to-face modality demonstrated significant improvements in self-management and its dimensions (knowledge, adherence, and management of signs and symptoms) both in the short and medium term. In contrast, participants enrolled in online modality did not show statistically significant improvements.\u003c/p\u003e \u003cp\u003eAlthough both delivery formats share the objective of fostering active health self-management, the results suggest that face-to-face modality more effectively promotes these behaviors. This can be explained by the influence of the social component through vicarious learning, modeling, and self-efficacy, components of Bandura's social learning theory, which appear to be more strongly activated in in-person settings. Therefore, it is suggested that, in order to ensure equity in the benefits of the program, it is necessary to strengthen the online implementation with technological and support strategies that encourage active participation, consolidation, and collective learning.\u003c/p\u003e \u003cp\u003eFinally, the apparent advantage of the face-to-face modality should be interpreted with caution due to several limitations: the overall sample size, the unequal number of participants between modalities, the non-random assignment to groups, differences in instrument administration formats (paper-and-pencil vs. Google Forms), and attrition at follow-up. Future research should include larger probabilistic samples, randomized group assignment, and standardized procedures for instrument administration to minimize potential sources of bias.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e It has been ethically approved by the Research Ethics Committee of the Faculty of Nursing at the Autonomous University of Tamaulipas, Tampico campus, under registration number FET/CI/2023/002. Informed written consent was collected from all participants in the current study. The study followed the guidelines established in the Regulations of Mexico\u0026rsquo;s General Health Law on Health Research and the Declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot Applicable\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare no conflicts of interest. The sponsors had no role in the design of the study; in the collection, analysis, or interpretation of data; in the writing of the manu-script; or in the decision to publish the results\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003e The authors are grateful to the Secretariat of Science, Humanities, Technology, and Innovation for funding project CF-2023-G-1394, titled \"Self-management strategies to im-prove the health of people with chronic diseases and family caregivers. A Network-Based Approach\u0026rdquo;, from which this manuscript is derived.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization IPC and AADR.; methodology RCLH and EBMH, formal analysis, RCLH., JLAM; data curation, L.M.Q.V; writing\u0026mdash;original draft preparation RCLH, AADR, EBMH; writing\u0026mdash;review and editing, JLAM, IPC, TGG. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors gratefully acknowledge the voluntary participation of people with non-communicable diseases (NCDs) in this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eNot Applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOrganizaci\u0026oacute;n panamericana de la Salud. Enfermedades no transmisibles [Internet]. [cited 2025 Jun 11]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.paho.org/es/temas/enfermedades-no-transmisibles\u003c/span\u003e\u003cspan address=\"https://www.paho.org/es/temas/enfermedades-no-transmisibles\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInstituto Nacional de Estad\u0026iacute;stica y Geograf\u0026iacute;a. Estadist\u0026iacute;cas de defunciones registradas 2023 [Internet]. 2024 Nov [cited 2025 Jun 11]. 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Mixed Methods Study. 2024;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu Y, Wen J, Wang X, Wang Q, Wang W, Wang X et al. Associations between e-health literacy and chronic disease self-management in older Chinese patients with chronic non-communicable diseases: a mediation analysis. BMC Public Health. 2022;22(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKerari A, Bahari G, Alharbi K, Alenazi L. The Effectiveness of the Chronic Disease Self-Management Program in Improving Patients\u0026rsquo; Self-Efficacy and Health-Related Be-haviors: A Quasi-Experimental Study. Healthcare 2024, Vol 12, Page 778 [Internet]. 2024 Apr 3 [cited 2025 Jun 11];12(7):778. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mdpi.com/2227-9032/12/7/778/htm\u003c/span\u003e\u003cspan address=\"https://www.mdpi.com/2227-9032/12/7/778/htm\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"self-management, self-efficacy, chronic disease, program evaluation, effective-ness","lastPublishedDoi":"10.21203/rs.3.rs-8041377/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8041377/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study compared the effectiveness of the Chronic Disease Self-Management Program delivered in face-to-face and online modalities for individuals with non-communicable diseases (NCDs), aiming to evaluate its impact on self-management and self-efficacy. A pre-experimental design with repeated measures (pretest, post-test, and three-month follow-up) was used in two independent groups (face-to-face n\u0026thinsp;=\u0026thinsp;52, online n\u0026thinsp;=\u0026thinsp;25), the Partners in Health Scale and the Self-Efficacy for the Management of Chronic Diseases instrument, both validated tools, were used. The results showed that although both groups started from similar conditions, the face-to-face modality produced statistically significant improvements in self-management and self-efficacy, which were sustained in the medium term, while the online modality did not show significant changes. These differences may be attributed to factors such as group interaction, technical support, and participants\u0026rsquo; digital literacy. It is concluded that in-person training may yield better outcomes in self-management; however, findings should be interpreted with caution due to the small sample size.\u003c/p\u003e","manuscriptTitle":"Results of a self-management program for non-communicable diseases in its face-to-face and online versions: a comparative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-13 09:08:20","doi":"10.21203/rs.3.rs-8041377/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-13T18:30:05+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-13T04:15:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-07T15:23:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"184163856936931542393097817183839007308","date":"2026-04-06T04:47:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"125234602039370003420709960660356513393","date":"2026-04-02T09:50:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-01T02:39:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"65821952337280466303252690382013611223","date":"2026-03-28T17:12:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"103678630273642441982273474236398635260","date":"2026-03-27T01:29:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"7725855808774214765040930841769040248","date":"2026-01-10T06:20:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"285717780050999357085215891430654235358","date":"2026-01-10T05:44:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"285025054200723530804381843305222027083","date":"2026-01-09T14:33:28+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-08T05:42:03+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-26T06:18:02+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-26T15:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-25T04:38:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-11-25T04:35:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1f84fb2d-ff3d-4ef3-8502-4f099820f4e2","owner":[],"postedDate":"January 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T12:24:58+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-13 09:08:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8041377","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8041377","identity":"rs-8041377","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}