title: Interactive media for diabetes self-management: issues in maximizing public health impact.
abstract: BACKGROUND
  Diabetes self-management presents a series of challenging tasks, and primary care, where the majority of cases of adult diabetes are treated, is hard-pressed to address these issues given competing demands. This article discusses how interactive media (IM) can be used to support diabetes self-management.
  
  
  METHODS
  Following a brief review of the literature, the 5 As framework for enhancing the effectiveness of health behavior counseling and the RE-AIM model for estimating and enhancing public health impact are used to frame discussion of the strengths and limitations of IM for diabetes shared decision making and self-management support.
  
  
  RESULTS
  Data and lessons learned from a series of randomized trials of IM for diabetes self-management education are summarized around 2 key issues. The first is enhancing patient engagement in decision making and includes enhancing user experience and engagement, improving quality of care, and promoting collaborative action planning and follow-up. The second is getting such resources into place and sustaining them in real-world primary care settings and involves enhancing participation at patient, clinician, and health care system levels and enhancing the generalizability of results.
  
  
  CONCLUSIONS
  . Key opportunities for IM to support diabetes self-management include assessment of information for shared decision making, assistance with problem-solving self-management challenges, and provision of follow-up support. A key current challenge is the linkage of IM supports to the rest of the patient's care, and collection of cost-effectiveness data is a key need for future research.
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, USA. russg@re-aim.net
authors.forename: Russell E
authors.initials: RE
authors.lastname: Glasgow
mesh_terms: D003299:Cooperative Behavior; D003657:Decision Making; D003661:Decision Support Techniques; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000517:prevention & control*; D015438:Health Behavior; D006266:Health Education; D006801:Humans; D010353:Patient Education as Topic / Q000379:methods*; D018802:Patient-Centered Care; D010379:Peer Group; D011634:Public Health / Q000379:methods*; D012648:Self Care / Q000379:methods*