The soaring rate of chronic illness has led behavioral and health care scientists to think of ways to reach and educate these patients. The result has been self-management, an approach born less of initial curiosity than of immediate necessity. Traditional approaches, such as residential treatment centers for asthma, were forced to give way for strategies that would reach a much greater population of patients. The movement, now fueled more by curiosity and creativity, is continuing. Russ Glasgow and his colleagues, for example, noted there remained a need for practical, efficient, and broad-reaching diabetes self-management interventions that can produce changes in lifestyle behaviors such as healthy eating and weight loss. The objective of their study was to evaluate whether the need they saw could be solved by a computer-assisted intervention. In the study, 335 Type 2 diabetes primary care patients from fee-for-service and health maintenance organization settings were randomized to social cognitive theory-based tailored self-management (TSM) or to computer-aided enhanced usual care (UC). The intervention they introduced consisted of computer-assisted self-management assessment and feedback, tailored goal-setting, barrier identification, and problem-solving, followed by health counselor interaction and follow-up calls. The outcomes were changes in dietary behaviors (fat and fruit/vegetable intake), hemoglobin Alc, lipids, weight, quality of life, and depression. Glasgow and his coworkers found that TSM patients reduced dietary fat intake and weight significantly more than UC patients at the 2-month follow-up. Among patients having elevated levels of HbA1c, lipids or depression at baseline, there were consistent directional trends favoring intervention, but these differences did not reach significance.

COMMENTS: The intervention proved feasible and was implemented successfully by a variety of staff. Russ and his colleagues found that their relatively low-intensity intervention, (a) appealed to a large, generally representative sample of patients; (b) was well implemented; and (c) produced improvement in targeted behaviors. This was an exciting study as it suggested ways that the ever growing population of type 2 diabetes patients might acquire and perform self-management skills. As many think that the size of this population has now reached epidemic proportions, use of the computer-assisted self-management program is apt to be the key to helping these patients care for themselves.

R.E. Glasgow et al. Effects of a brief computer-assisted diabetes self-management intervention on dietary, biological and quality-of-life outcomes. Chronic Illness, 2006;2:27-38.