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Perspectives on Self-Management From the Diabetes Initiative of the Robert Wood Johnson Foundation

From the School of Public Health, University of North Carolina at Chapel Hill (Dr Fisher) and the National Program Office of the Robert Wood Johnson Foundation Diabetes Initiative, Division of Health Behavior Research, Departments of Internal Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O'Toole, Ms Anwuri, Ms Shetty).

Correspondence to Edwin B. Fisher, PhD, Department of Health Behavior and Health Education, School of Public Health, Rosenau Hall, CB 7440, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7440 (fishere{at}email.unc.edu).

Purpose and Method

Review and highlight findings from the projects of the Diabetes Initiative of the Robert Wood Johnson Foundation® described in this special supplemental issue.

Results

The broad framework for self-management around which these programs were developed, "Resources and Supports for Self Management," includes individualized assessment, collaborative goal setting, building skills for self-management, ongoing follow-up and support, community resources, and continuity of quality clinical care. Lessons learned include the central role of community health workers in self-management, the importance of ongoing follow-up and support to sustain self-management, varied program approaches to depression and negative emotion, the importance of organizational infrastructure to support self-management programs, and the contributions of clinic-community partnerships. Several emergent themes include the value of providing choices among "good practices" as opposed to one best practice, the role of the physician as part of the self-management team, and the importance of broad efforts in promoting dissemination of self-management programs. Finally, self-management will benefit from replacing categorical distinctions, like good and bad control, proven and unproven treatment, with thinking in terms of key dimensions, like level of control and continued quality improvement.

Conclusions

Diabetes Initiative projects have shown that diabetes self-management can be promoted in the "real worlds" of community agencies and primary care settings serving diverse and disadvantaged populations.

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