Ecological approaches to self-management: the case of diabetes.
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.
Fisher
Edwin B
EB
Washington University, Division of Health Behavior Research, 4444 Forest Park Ave, St Louis, MO 63108, USA. efisher@im.wustl.edu
Brownson
Carol A
CA
O'Toole
Mary L
ML
Shetty
Gowri
G
Anwuri
Victoria V
VV
Glasgow
Russell E
RE
D002908:Chronic Disease; D003142:Communication; D003266:Continuity of Patient Care; D003299:Cooperative Behavior; D003920:Diabetes Mellitus / Q000628:therapy*; D019468:Disease Management; D004463:Ecology; D006801:Humans; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D010358:Patient Participation; D010817:Physician-Patient Relations; D012648:Self Care; D012944:Social Support