Ecological Approaches to Self-Management: The Case of Diabetes

Abstract

In the Diabetes Initiative of The Robert Wood Johnson Foundation, an ecological perspective helped identify the following key resources and supports for self-management (RSSM): individualized assessment, collaborative goal setting, skills enhancement, follow-up and support, access to resources, and continuity of quality clinical care. These RSSM reflect the grounding of diabetes self-management in the context of social and environmental influences. Research supports the value of each of these key resources and supports. Differences among self-management interventions may be seen as complementary, rather than conflicting, ways of providing RSSM. This way of understanding differences among interventions may aid development of varied programs to reach diverse audiences. In contrast to the "5 A's" model of key provider services (Assess, Advise, Agree, Assist, and Arrange), RSSM articulate self-management from the perspective of individuals' needs. Both approaches emphasize identification of goals, teaching of skills, and facilitation and reinforcement of the use of those skills.

Linking internet-based diabetes self-management to primary care: lessons learned and implications for research translation and practice implementation

“…physical activity, and medication taking has been demonstrated to improve diabetes outcomes and quality of life, and reduce the risk of complications [7][8][9], at least short term. Self-management support that includes behavioral goal setting and follow-up support is highly recommended as an effective strategy for improving chronic illness [10], but may be insufficient if not well integrated into patients' lives and reinforced through their routine diabetes care [11].…”

Preferences for self-management support: Findings from a survey of diabetes patients in safety-net health systems

“…Self-management is the cornerstone of diabetes care, and patients with diabetes must perform multiple self-management activities on a regular basis to help prevent adverse outcomes (1)(2)(3). Unfortunately, diabetes-specific disease management support occurs inconsistently during outpatient visits, and information that patients receive is often poorly understood or does not take into account their values and life circumstances (4,5).…”

Supporting implementation of evidence-based behavioral interventions: the role of data liquidity in facilitating translational behavioral medicine

“…Here, access to all data potentially relevant to the individual patient at hand will powerfully support clinical care and decision-making; personalized medicine, though traditionally viewed as the tailoring of patient care using novel genomic and biomarker information, can be defined for behavioral medicine purposes as the provision of individual-specific care that takes account of the patient's health-related data in the context of an ecological model of health that includes multiple levels from cells to society [28]. For example, the care of an older individual experiencing chronic and severe pain may require a treatment plan informed by the patient's age, any physical disability, obesity, history of depression, history of medications, family history, employment history, place of residence, and social support.…”