Frequently-Asked Questions About Tomando

What is Tomando?

Tomando Control de su Salud is a community-based workshop given two and a half hours, once a week, for six weeks. Spanish-speaking people with different chronic health problems attend together. Workshops are facilitated by two trained certified and active leaders, one or both of whom are non-health professionals with a chronic disease themselves. All workshops are given in Spanish without translators.


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. They include: 1) healthy eating, 2) appropriate exercise for maintaining and improving strength, flexibility, and endurance, 3) managing depression, 4) appropriate use of medications, 5) communicating effectively with family, friends, and health professionals, 6) relaxation techniques, 7) appropriate use of the health care system, 8) how to evaluate new treatments, and 9) better breathing.


Each participant in the workshop receives a copy of the companion book, Tomando Control de su Salud: Una guía para el manejo de las enfermedades del corazón, diabetes, asma, bronquitis, enfisema y otros problemas crónicos, an audio relaxation CD, Casete de Relajación, and an audio exercise CD with booklet, ¡Hagamos ejercicio! All materials are in Spanish.


It is the process in which the program is given 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.


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., Virginia González, M.P.H., and Maria Hernández Marin. 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 should contact WIHA. Leaders must be fully fluent in Spanish (read, write and speak) and have a chronic condition. Training for Leaders is 4 days. Stanford 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). All training is done in Spanish. Program participants must speak Spanish but reading and writing are not necessary.