title: Comprehensive Self-Management Strategies.
abstract: In this article, we provide a review of the literature on self-management interventions and we are giving some thought to how, when, and by whom they should be offered to patients. The present literature based on randomized clinical trials has demonstrated benefits (reduced hospital admissions and improved health status) for chronic obstructive pulmonary disease (COPD) patients undergoing self-management interventions, although there are still problems with the heterogeneity among interventions, study populations, follow-up time, and outcome measures that make generalization difficult in real life. Key to the success, self-management intervention has to target behavior change. Proper self-management support is a basic prerequisite, for example, techniques and skills used by health care providers "case manager" to instrument patients with the knowledge, confidence, and skills required to effectively self-manage their disease. To improve health behaviors and engagement in self-management, self-management interventions need to target enhancing intrinsic motivation to change. This will best be done using client-centered communication (motivational communication) that encourages patients to express what intrinsically motivates them (e.g., consistent with their values or life goals) to adopt certain health behavior, with the goal of helping them overcome their ambivalence about change. Finally, if we want to be able to design and implement self-management interventions that are integrated, coherent, and have a strong likelihood of success, we need to take a more careful look and give more attention at the case manager, the patient (patient evaluation), and the quality assurance.
authors.affiliation: Montreal Chest Institute, McGill University Health Centre, Montréal, Quebec, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Bourbeau
authors.affiliation: Department of Psychology, University of Quebec at Montreal. Montreal, Quebec, Canada.
authors.forename: K L
authors.initials: KL
authors.lastname: Lavoie
authors.affiliation: Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre and McGill University, Montreal, Quebec, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Sedeno
mesh_terms: D032763:Behavior Control / Q000379:methods / Q000523:psychology; D019090:Case Management / Q000592:standards; D015438:Health Behavior; D006801:Humans; D017063:Outcome Assessment, Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology / Q000628:therapy; D011785:Quality Assurance, Health Care; D011788:Quality of Life; D012648:Self Care / Q000379:methods / Q000523:psychology