approaches used in diabetes self-management interventions. The first, community telephonic interventions, falls under the community category of Ed Wagner’s Chronic Care Model (see Chapter 3, Figure 3-1). The goal of these interventions is to produce informed and active patients who interact productively with their health care teams to improve outcomes (Wagner, 1998; Wagner et al., 2001). The second approach she discussed, the socialecological model, is used to inform the development of interventions that address individual behavior and influences within their environment of family, community, culture, and policy issues (Fisher et al., 2002; Stokels, 1996).
Walker suggested that diabetes self-management interventions include methods for addressing the American Association of Diabetes Educators’ seven self-care behaviors:
1. healthy eating
2. being active
4. taking medication
5. problem solving
6. healthy coping
7. reducing risks
Since types 1 and 2 diabetes are chronic conditions, Walker suggested that psychosocial interventions should focus on treatment adherence through motivating behavior change and emotional support. These interventions include goal setting, problem solving, maintenance strategies, continuing support, and treatment of distress and psychiatric disorders such as depression. In addition, the interventions should include some form of activation, such as coaching or empowerment, and be tailored to meet the individual’s needs (Peyrot and Rubin, 2007).
A telephonic intervention can be used as a stand-alone intervention, or as part of a multicomponent intervention such as one that includes face-to-face interviews. Depending on available funding, the intervention can consist of an automated voice message, text message (personalized or not), or person-to-person conversation. Walker noted that the interventions she developed involve person-to-person conversations because she and her researchers have not determined appropriate wording for an automated voice or text message that would effectively improve motivation or self-care behaviors. Telephonic interventions can be used multiple ways within an intervention, such as focusing on improving participants’ glycemic control