The purpose of this integrative review is to evaluate research pertaining to self-management programs for older adults with chronic diseases using Albert Bandura's Social Cognitive Theory (SCT) for behavior change. The focus is application of the SCT domains to self-management programs. The exploration of the current chronic disease self-management research provides an understanding of the Social Cognitive Theory concepts studied in interventional self-management research. The integrative review explicated two areas related to the theory in need of further research. First, social support has not been thoroughly explored as a mechanism for enhancing self-management interventions. Second, moral disengagement was not identified as a focus within chronic disease research raising the question about the impact of moral disengagement on longterm adherence and behavior change.

With the older adult population projected to increase substantially in the next 10 years, the incidence of chronic disease will become a significant factor in the burden of disease both globally and within the United States. The chronic disease state has been shown to decrease quality of life and the life expectancy of those individuals. In Tennessee the incidence of chronic disease, lower incomes, and education levels increases the risk of decreased quality of life and increased mortality in the older adult population. A review of literature by the researcher reveals that scant research has focused upon the older adult's perspective toward chronic illness and making changes to their health routine. As part of a mixed-method correlational study, focus groups used a descriptive qualitative approach to increase understanding of the phenomenon of chronic illness. The purpose of this qualitative study was to determine the attitudes and perceptions of older adults in East Tennessee towards behavior change and health maintenance in chronic disease.

The population of older adults with chronic disease is increasing, yet little is known about their perception of chronic disease and self-management. To develop successful and sustainable chronic disease self-management interventions in the older adult population, health care providers must first understand older adults' attitudes toward health status and behavior change. This pilot study was conducted to determine the feasibility of the study design. The purpose of this pilot study was to assess the appropriateness of using a mixed-methods research design to investigate Appalachian older adult's attitude toward the chronic disease experience and health behavior change. A convergent, parallel mixed-method design included a quantitative questionnaire and qualitative focus groups in churches in northeast Tennessee. The aim of the study was met, and the methodology of the study was found to be feasible for larger studies. Divergence of data was found when evaluating qualitative and quantitative data. The study instrument was found to be reliable for future use. The implications of the results suggest that the study design is appropriate for the purpose of the study.

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