title: Factors associated with integrating self-management support into primary care.
abstract: The purpose of this article is to expand the understanding of self-management support by describing factors that contribute to implementing a comprehensive self-management program in primary care.
  
  
  
  Four rural health centers in medically underserved areas participated in a study to document the implementation of a self-management program. This program consisted of a social marketing plan and decision-making tools to guide patients in making self-management behavior changes. The stages of change constructs of the transtheoretical model were used to design the social marketing plan. Key informant interviews were conducted at 6-month and 9-month intervals to document the implementation process. A standardized set of questions was used in the interviews. The data from the interviews were analyzed using content analysis techniques.
  
  
  
  One of the principle findings is that self-management support requires putting a system in place, not just adding a new component to primary care. The health centers that fully implemented the self-management program made an organizational commitment to keep self-management on the agenda in management meetings, clinical staff set the example by adopting self-management behaviors, and patient self-management support was implemented in multiple patient care venues.
  
  
  
  Primary care centers with limited financial resources are able to integrate self-management support into their system of chronic illness care.
authors.affiliation: The Joan C. Edwards School of Medicine, Marshall University, Department of Family and Community Health, Huntington, West Virginia (Dr Crespo)
authors.forename: Richard
authors.initials: R
authors.lastname: Crespo
authors.affiliation: South Bend, Indiana (Ms Shrewsberry)
authors.forename: Molly
authors.initials: M
authors.lastname: Shrewsberry
mesh_terms: D015438:Health Behavior; D006801:Humans; D010353:Patient Education as Topic; D011320:Primary Health Care; D012424:Rural Population; D012648:Self Care; D014903:West Virginia