Perhaps the major barrier to self-management for chronic illness is ensuring that once patients learn self-management skills, they continue to perform them. Data on the long-term maintenance of self-management is sadly lacking, a huge flaw in that chronic illness requires chronic self-management. Different approaches have been taken, but Bradshaw and coworkers tested the efficacy of resiliency training for people who have previously received diabetes self-education. A randomized design was employed with repeated measures (baseline, 3 months, 6 months) with 67 participants assigned to either treatment as usual or the resiliency classes. Outcome variables included physiological measures (blood sugar, waist measurement, eating and exercise habits) and psychosocial measures (self-efficacy, locus of control, social support, and purpose in life). Analyses of the data indicated that the intervention group had higher levels of resiliency as reported by knowing positive ways of coping with diabetes-related stress, knowing enough about themselves to make right diabetes choices, having fun in life, eating healthier, and increasing physical activity compared with the control group at 3 months. Blood sugar and waist measurement improved but not significantly.

VALUE OF STUDY TO READER: The authors concluded that the resiliency approach in tandem with standard diabetes education programs could assist their patients to become more self-directed in their diabetes care. This may be true. The approach is one tactic that may be taken to improve the performance and maintenance of self-management skills in patients with a chronic illness. However, this was not shown in the current study and awaits future research. As noted at the outset, the issue of chronic self-management is the major barrier in the control of chronic illness.

B.G. Bradshaw et al. Determining the efficacy of a resiliency training approach in adults with type 2 diabetes. Diabetes Education, 2007;33:650-659.