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AJPH First Look, published online ahead of print Jul 28, 2005
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September 2005, Vol 95, No. 9 | American Journal of Public Health 1523-1535
© 2005 American Public Health Association
DOI: 10.2105/AJPH.2005.066084

PUBLIC HEALTH MATTERS

Ecological Approaches to Self-Management: The Case of Diabetes

Edwin B. Fisher, PhD, Carol A. Brownson, MSPH, Mary L. O’Toole, PhD, Gowri Shetty, MS, MPH, Victoria V. Anwuri, MPH and Russell E. Glasgow, PhD

Edwin B. Fisher, Carol A. Brownson, Mary L. O’Toole, Gowri Shetty, and Victoria V. Anwuri are with the National Program Office of The Robert Wood Johnson Foundation Diabetes Initiative, Washington University, St Louis, Mo. Russell E. Glasgow is with the Kaiser Permanente Colorado Clinical Research Unit, Penrose, Colo.

Correspondence: Requests for reprints should be sent to Edwin B. Fisher, PhD, Washington University, Division of Health Behavior Research, 4444 Forest Park Ave, St Louis, MO 63108 (e-mail: efisher{at}im.wustl.edu).

In the Diabetes Initiative of The Robert Wood Johnson Foundation, an ecological perspective helped identify the following key resources and supports for self-management (RSSM): individualized assessment, collaborative goal setting, skills enhancement, follow-up and support, access to resources, and continuity of quality clinical care. These RSSM reflect the grounding of diabetes self-management in the context of social and environmental influences. Research supports the value of each of these key resources and supports. Differences among self-management interventions may be seen as complementary, rather than conflicting, ways of providing RSSM. This way of understanding differences among interventions may aid development of varied programs to reach diverse audiences. In contrast to the "5 A’s" model of key provider services (Assess, Advise, Agree, Assist, and Arrange), RSSM articulate self-management from the perspective of individuals’ needs. Both approaches emphasize identification of goals, teaching of skills, and facilitation and reinforcement of the use of those skills.




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