In part 1, a half dozen features of effective self-management were outlined. The remaining characteristics are described in this entry.

7. Record and inspect qualitative and quantitative data you gather on yourself. This activity may sound like a no-brainer, but it isn’t. In self-monitoring, we may think that only our physician or health care provider is interested in the data we gather. They should be interested in the information you give them, particularly if they ask you to collect it. However, it has been our experience that patients often discover interesting patterns and valuable insights about their illness on their own. If your suffer migraine, for example, you may review what happened over several flare-ups. You may find that certain stimuli or warning signs occurred just before the headaches. If you can prevent them from occurring or if you can spot them early in a migraine, maybe you can prevent or halt an episode more quickly. You are the one experiencing the chronic condition; you may find that only you acquire the insights that help you manage it better than anyone.

8. Reinforce yourself. We are often reinforced for doing something via praise from others or financial remuneration. Yet the most effective and common reinforcement that changes and maintains our behavior is referred to as self-directed reinforcement or self-reinforcement. When you engage in activities, such as refraining from eating sweets during the holiday season, it may help keep your blood glucose levels on an even keel. Is anyone likely to reinforce you for doing so well in controlling your diabetes? Not likely. For that reason, you should take pride or satisfaction in a job well done. That is self-reinforcement. It may not always be enough to promote behavior change or to maintain the changes, but it is about all that we each can do to achieve the goals we have regarding control over our chronic condition.

9. Assess how well you do in controlling your condition at all times and in different settings. You may find that you are good at controlling a high level of cholesterol when you are at home. You or a member of your family may prompt you to do so by preparing meals that help you to do so. When out in a different environment, however, things may change. If you are in a restaurant, it is often hard to pass up foods with lower cholesterol in favor of food with the opposite characteristics. As there may be no one there to remind you to do otherwise, you may cave in to temptation and eat what you’ve been warned to avoid. Much of your behavior is, of course, a natural way that any of us would react. However, if you are serious about reducing your cholesterol level, you want to broaden the number of settings where you control your behavior. You can do so by reviewing the choices you have and the decision you wish to make. You’ll likely not be successful all the time, but you may discover that you are gradually remaining on a low-cholesterol diet across more and more settings. This outcome is reason enough for self-reinforcement.

10. Frequently revise your self-management skills, their effectiveness, and decide whether any can be changed or refined for better outcomes. It pays to review periodically what you did that worked and what you might do better to control your chronic illness in the future. Some patients, particularly those who have developed a keen sense of imagery, find that they can go back and review each step they performed both in the daily management of their condition or in controlling an exacerbation of the disease. They become very much aware of what actions worked and what actions were unnecessary; they can then make adjustments as to their future behavior. Revising self-management skills is strictly a personal decision: you may have been taught general strategies to perform to control your condition but find they are not that helpful to you. In this case, do what you found works better for you. The best lesson we’ve learned in teaching patients self-management skills over the past 40 years is that we learned more from them than we ever taught them.

11. Provide strong support to yourself for accepting responsibility for the management of your chronic illness. Let’s face it: if you don’t reinforce and support yourself for doing the day-to-day actions for managing your chronic illness, no one else will. You may receive some reinforcement and encouragement from health care providers or family members, but this is for your general behavior; these sources of support are not always there when you perform many of the tasks required to control a chronic illness. It was suggested that you use self-reinforcement contingent upon your successful performance. However, self-reinforcement is usually a murky concept and not always easy to apply on a consistent manner. The best thing is to use intrinsic reinforcement of some manner, a topic that will be explored in an upcoming entry.

12. Repeatedly summarize and reiterate key skills required to self-manage your condition. Basically, this requires that you summarize your performance over time and across settings. What worked for you? What didn’t work? Only you know the answer to these questions. Many of you will develop strategies that work for you, although you were not taught these techniques. That’s great as progress in self-management will mainly result from the observations and reports of you and others with a chronic illness.

Good luck in using these suggestions!