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DOI: 10.1177/0145721706297454 © 2007 American Association of Diabetes Educators; Published by SAGE Publications
The Robert Wood Johnson Foundation Diabetes InitiativeDemonstration Projects Emphasizing Self-managementFrom the Department of Health Behavior and Health Education, School of Public Health, University of North Carolina at Chapel Hill (Dr Fisher); 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); the Department of Family Health and Community Health Nursing, School of Nursing, Southern Illinois University, Edwardsville, Illinois (Ms Fazzone); the Health Promotion and Exercise Science Department, School for Professional Studies, Western Connecticut State University, Danbury (Dr Housemann); the Health Promotion Department, US Naval Hospital, Okinawa, Japan (Ms Hampton); Health, Social, and Economics Research, RTI International, Research Triangle Park, North Carolina (Dr Kamerow, Dr McCormack, Mr Burton); and the Robert Wood Johnson Foundation, Princeton, New Jersey (Dr Orleans and Dr Bazzarre). Correspondence to Edwin B. Fisher, PhD, Department of Health Behavior and Health Education, School of Public Health, University of North Carolina at Chapel Hill, Rosenau Hall, CB #7440, Chapel Hill, NC 27599-7440 (fishere{at}email.unc.edu). Purpose 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. Methods 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. Results 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. Conclusions 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.
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