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• W2084799302 abstract "Diabetes is a fascinating disease. On the one hand, it is a pure biomedical disease, with clear pathophysiology, numerous effective technological management strategies and a gold standard outcome (glycated hemoglobin). On the other hand, diabetes is a behavioural illness, in which the achievement of positive outcomes rests to a great extent on the situation-specific behavioural choices of the person with diabetes and the psychosocial context in which the person lives. Also fascinating is the fact that diabetes is, in many ways, the prototype of chronic disease management through interdisciplinary teams, the current model of care dominating health systems. The history of diabetes care is a nice backdrop to the current recognition within healthcare systems of the importance of self-management through personal responsibility. There was a time when we talked about the non-compliant diabetic (I italicize this term as a reference to a historical term and in respect of Canadian Diabetes Association policy). Then we started talking about adherence to diabetes regimens and then about self-care plans and behaviours. So we diabetes professionals have a pedigree in the area of self-management support. I am proud to say that the diabetes program I am associated with at Capital Health in Halifax made a conscious decision over 10 years ago to rename ourselves from an Education Centre to a Management Centre. The American Diabetes Association has just published National Standards for Diabetes Self-Management Education, in which they distinguish Self-Management Education from Self-Management Support (1Funnell M. Brown T. Childs B. et al.National standards for diabetes self-management education.Diabetes Care. 2012; 35: S101-S108Crossref PubMed Scopus (149) Google Scholar). All of this is to say that the concepts of self-management (what the person living with diabetes does) and self-management education and support (what the diabetes healthcare provider does) are not new to diabetes professionals. So why a special issue on self-management support? Well, there is reason to believe that self-management support means a fundamental shift from a provider-centric model of care to a patient-centric model of care. That is, complex psychosocial issues such as motivation, support, self-efficacy, depression and emotional functioning as well as family, socioeconomic status and culture form the unavoidable context in which diabetes self-management occurs. Many clinicians are not well trained in managing such complexity and will benefit from a comprehensive review of the current state of self-management support. As well, self-management support interventions have also been developed outside of diabetes and there is much that we can learn from the chronic disease and health coaching literature. That is the justification for this special issue. We have been successful in receiving articles from many of the leading researchers and clinicians who are driving self-management in Canada. The articles in this special issue address conceptual issues, strategies for implementation and system issues. The hope is that interested readers will become informed about how to understand the complexities of self-management support, learn about innovative approaches to incorporate self-management support into clinical intervention, and how to approach system issues that might lead to changes that will increase the likelihood of sustainable programs being implemented. The special issue begins with a commentary by Sherifali, Jones and Mullan, who put the general self-management support concept into the context of the diabetes world, including the important idea that self-management might not be appropriate for all. This is followed by a review article by Wong-Rieger and Rieger, who provide a nice review of the health coaching concept and how it can be integrated into diabetes management. With these articles as a background, we present 4 articles that are more method-focused. Pearson, Irwin, Morrow, Battram and Melling present a randomized intervention comparing health coaching/motivational interviewing to a more prescriptive cognitive behavioural lifestyle intervention for weight loss in a sample of obese university students. Liddy, Cullen-Arseneau, Merizzi and Blazhko present a primary prevention (pre-diabetes) program that they have developed in Ottawa using a self-management support model and focus on challenges and opportunities for implementing successful research trials into primary care settings. Sabourin and Pursely provide a nice contextual article that describes how to address some of the more complex psychosocial issues that present themselves within diabetes programs. The final methods article is by me. I have long been interested in operationalizing the component skills of self-management support interventions. In this article, I present the development and validation of the Behaviour Change Counselling Scale. The final 2 articles in this issue are addressed at a system level. McGowan examines the challenges to implementing self-management support interventions into clinical settings such as diabetes programs. Finally, to end on a high note, Morrin, Britten, Davachi and Knight, from Alberta Health Services, present their Alberta Healthy Living Program, a province-wide demonstration of how self-management support can be incorporated at a system level. I hope this special issue is informative and stimulates continued interest in how to conceptualize, operationalize, implement and evaluate self-management support models for diabetes as well as other chronic diseases." @default.
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• W2084799302 date "2013-02-01" @default.
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• W2084799302 title "We've Come a Long Way…Haven't We?" @default.
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• W2084799302 doi "https://doi.org/10.1016/j.jcjd.2013.02.020" @default.
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