The Chronic Disease Self-Management Program study was designed to test the general applicability of self-management programs to mixed groups having different chronic diseases. In this study, 1,140 persons 40 years of age or older with at least one of the targeted diseases (heart disease, lung disease, stroke and/or arthritis) were randomized to receive a 7-week (2.5 hours per week) peer-led, community-based self-management program or to usual care control status. Treatment groups included patients with different chronic diseases. After six months, the controls received the Chronic Disease Self-Management Program. Subjects participating in the program were followed for between one and three years. Content of the English Chronic Disease Self-Management Program was based on a literature review and input from 11 focus groups.71, 72 The self-management activities focused on the skills needed to manage the tasks involved in dealing with chronic illness as described by Corbin and Strauss.73 These include: 1) treatment tasks necessitated by the illness such as exercise, symptom management, taking medication(s), and communicating with health care providers, 2) tasks needed to maintain or alter one's life roles in the face of the chronic condition, and 3) emotional tasks such as dealing with anger, depression and an uncertain future. The course development was informed by self-efficacy theory and taught using efficacy-enhancing strategies that included emphasis on skills mastery, modeling, reinterpretation of symptoms, and social persuasion.