Tomando Control de su Salud (Spanish Chronic Disease Self-Management Program)

The teaching process makes this program effective. Classes are highly participatory. Mutual support and success builds participants’ confidence in their ability to manage their health and maintain active and fulfilling lives.

Important note: Although very similar, Tomando is not a translation of the Chronic Disease Self-Management Program. It was originally developed separately. Topics are similar, but they are presented in ways that are culturally appropriate.


  • Small group workshop
  • 2 1/2 hours per session
  • 1 session per week for 6 weeks
  • It is the process in which the program is taught that makes it effective. Classes are highly participative, where mutual support and success build the participants’ confidence in their ability to manage their health and maintain active and fulfilling lives.
  • All workshops are given in Spanish without translators.


  • Community settings such as senior centers, churches, libraries and hospitals.
  • Special attention should be given to making the location accessible to all.
  • A room large enough for all participants to gather comfortably, plus space for 2 leaders and their materials.


  • Spanish-speaking individuals managing a wide variety of chronic conditions participate together
  • 12-16 participants per workshop

Participant Materials


  • 2 trained, Spanish-speaking leaders, one or both of whom are non-health professionals with chronic conditions themselves.
  • Must be trained by certified Master Trainers, or must be Master Trainers themselves.

Subjects Taught

(Note: Participants make weekly action plans, share experiences, and help each other solve problems they encounter in creating and carrying out their self-management program. Physicians and other health professionals both at Stanford and in the community have reviewed all materials in the workshop.)

  • Healthy eating
  • Appropriate exercise for maintaining and improving strength, flexibility, and endurance
  • Managing depression
  • Appropriate use of medications
  • Communicating effectively with family, friends, and health professionals
  • Relaxation techniques
  • Appropriate use of the health care system
  • How to evaluate new treatments
  • Better breathing.

Frequently Asked Questions

Does the Program replace existing programs and treatments?

The Program will not conflict with existing programs or treatment. It is designed to enhance regular treatment and disease-specific education such as Better Breathers, cardiac rehabilitation, or diabetes instruction. In addition, many people have more than one chronic condition. The program is especially helpful for these people, as it gives them the skills to coordinate all the things needed to manage their health, as well as to help them keep active.

How was the Program developed?

The Department of Medicine in the School of Medicine at Stanford University received a five year research grant from the National Institute of Nursing Research (NINR) and the State of California Tobacco-Related Diseases office. The purpose of the research was to develop and evaluate, through a randomized controlled trial, a community-based Spanish-language self-management program that assists Latinos with chronic illness.

The Program was developed by Kate Lorig, Dr.P.H. and Virginia González, M.P.H..

The process of the program was based on the experience of the investigators and others with self-efficacy, the confidence one has that he or she can master a new skill or affect one’s own health. The content of the workshop was the result of focus groups in Spanish with people with chronic disease, in which the participants discussed which content areas were the most important for them.

How was the Program evaluated?

Over 500 Spanish-speaking people with heart disease, lung disease, or diabetes participated in a randomized, controlled test of the Program, and were followed for one year. We looked for changes in many areas: health status (disability, social/role limitations, pain and physical discomfort, fatigue, shortness of breath, health distress, self-rated general health), health care utilization (visits to physicians, visits to emergency department, hospital stays, and nights in hospital), self-efficacy (confidence to perform self-management behaviors, confidence to manage disease in general, confidence to achieve outcomes), and self-management behaviors (exercise, cognitive symptom management, mental stress management/relaxation, communication with physician).

What were the results?

At four months, the participants, as compared with usual-care control subjects, demonstrated improved health status, health behavior, and self-efficacy, as well as fewer emergency room visits. At one year, the improvements were maintained and remained significantly different from baseline condition.**

How can my facility offer the Program?

Organizations interested in offering the program need to purchase a program license.

Leaders must be fully fluent in Spanish (read, write and speak) and have a chronic condition. Training for Leaders is 4 days. SMRC does not offer Leader trainings. Licensed organizations may organize Leader trainings.

Master Trainers must be fully fluent in Spanish. They can be peers or professionals and represent the organizations offering the workshop. Training for Master Trainers is 4½ days. We also offer web-based cross-training for those who have already been trained in the English Chronic Disease Self-Management Program (CDSMP). See our Web-Based Cross Training page for more information.

All training is done in Spanish. Program participants must speak Spanish, but reading and writing are not necessary.

*For information on these materials, see the materials page.

**Reported in: Lorig KR, Ritter PL, González VM. Hispanic Chronic Disease Self-Management: A Randomized Community-based Outcome Trial. Nursing Research, 52(6):361-9, 2003.