The Robert Wood Johnson Foundation Diabetes Initiative: demonstration projects emphasizing self-management.
The purpose of the Diabetes Initiative of the Robert Wood Johnson Foundation is to demonstrate feasible and sustainable approaches to promoting diabetes self-management in primary care and community settings.



The Diabetes Initiative of the Robert Wood Johnson Foundation includes 14 demonstration projects in primary care settings and in community-clinical partnerships. Projects serve predominantly indigent populations from varied cultural and linguistic backgrounds in urban, rural, and frontier settings around the United States. This report describes the Initiative, its ecological perspective on self-management, and implications for program development, sustainability, and dissemination.



Ecological perspectives stress varied levels of influence ranging from individuals to communities and policies. Based on this, the Initiative has identified key resources and supports for self-management (individualized assessment, collaborative goal setting, enhancing skills, follow-up and support, community resources, and continuity of quality clinical care). Lessons learned include the central roles of community health workers, integration of healthy coping and attention to negative emotion and depression in self-management, community partnerships, approaches to ongoing follow-up and support, organizational factors in sustaining programs, and the utility of a collaborative learning network for program development. Sustainability stresses organizational and policy supports for the program. Dissemination of lessons learned will stress collaboration among interested parties, stimulating consumer understanding and demand for self-management services as central to diabetes care.



The Diabetes Initiative demonstrates that effective self-management programs and supports can be implemented in real-world clinical and community settings, providing models of worthwhile, sustainable programs.
Fisher
Edwin B
EB
The Department of Health Behavior and Health Education, School of Public Health, University of North Carolina at Chapel Hill (Dr Fisher)
Brownson
Carol A
CA
National Program Office of the Diabetes Initiative of The Robert Wood Johnson Foundation, Division of Health Behavior Research, Departments of Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O’Toole, Ms Shetty, Ms Anwuri)
O'Toole
Mary L
ML
National Program Office of the Diabetes Initiative of The Robert Wood Johnson Foundation, Division of Health Behavior Research, Departments of Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O’Toole, Ms Shetty, Ms Anwuri)
Shetty
Gowri
G
National Program Office of the Diabetes Initiative of The Robert Wood Johnson Foundation, Division of Health Behavior Research, Departments of Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O’Toole, Ms Shetty, Ms Anwuri)
Anwuri
Victoria V
VV
National Program Office of the Diabetes Initiative of The Robert Wood Johnson Foundation, Division of Health Behavior Research, Departments of Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O’Toole, Ms Shetty, Ms Anwuri)
Fazzone
Patricia
P
The Department of Family Health and Community Health Nursing, School of Nursing, Southern Illinois University, Edwardsville, Illinois (Ms Fazzone)
Housemann
Robyn A
RA
The Health Promotion and Exercise Science Department, School for Professional Studies, Western Connecticut State University, Danbury (Dr Housemann)
Hampton
Andrea D
AD
The Health Promotion Department, US Naval Hospital, Okinawa, Japan (Ms Hampton)
Kamerow
Douglas B
DB
Health, Social, and Economics Research, RTI International, Research Triangle Park, North Carolina (Dr Kamerow, Dr McCormack, Mr Burton)
McCormack
Lauren A
LA
Health, Social, and Economics Research, RTI International, Research Triangle Park, North Carolina (Dr Kamerow, Dr McCormack, Mr Burton)
Burton
Joseph A
JA
Health, Social, and Economics Research, RTI International, Research Triangle Park, North Carolina (Dr Kamerow, Dr McCormack, Mr Burton)
Orleans
C Tracy
CT
The Robert Wood Johnson Foundation, Princeton, New Jersey (Dr Orleans and Dr Bazzarre)
Bazzarre
Terry L
TL
The Robert Wood Johnson Foundation, Princeton, New Jersey (Dr Orleans and Dr Bazzarre)
D003920:Diabetes Mellitus / Q000517:prevention & control / Q000534:rehabilitation*; D005582:Foundations; D006801:Humans; D010353:Patient Education as Topic; D012648:Self Care; D014481:United States