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P - Informed Self-Management

Informed Self-Management | Participation DL Wolfe, PhD; S Mills, MEd; J Shepherd, MBA; C Craven, MD; and the E-Scan Investigative Team Self-management comprises the interventions, training and skills provided to individuals with spinal cord injury (SCI) that support them in effectively managing all aspects of their lives (see Figure 1.0). This represents all meaningful aspects of life (relevant to the individual). Some of the typical strategies for enhancing self-management include methods for problem solving, self-monitoring, goal setting, action planning and enhancement of self-efficacy, in conjunction with education. Much of the current programming related to self-management has its basis in the conceptual framework of Wagner et al.’s Chronic Disease Model1 and, therefore, has been applied, most frequently, to “typical” chronic diseases – most specifically, to the conditions of diabetes, arthritis and cardiovascular disease. Recent efforts have been undertaken to translate these approaches to SCI (e.g., Ontario Neurotrauma Foundation-funded initiative of the Stanford Patient Education Centre approach to self-management, Lorig et al.2). A common model of self-management support is the Five-A model, summarized by Glasgow et al.3 and shown in Figure 2.0. Figure 2.0. Five A’s Model of Self-Management Support. © Joint Comision Resources: Implementing practical interventions to support chronic ilnes self-management. Joint Comision Journal of Quality and Safety, 29(11):563-74, 2003.3 Reprinted with permision. ASSESS: Beliefs, Behaviour & Knowledge PERSONAL ACTION PLAN 1. List specific goals in behavioural terms 2. List barriers and strategies to address barriers 3. Specify follow-up plan 4. Share plan with practice team and patient’s social support ADVISE: Provide specific information about health risks and benefits of change AGREE: Collaboratively set goals based on patient’s interest and confidence in his/her ability to change behaviour ARRANGE: Specify a plan for follow-up (e.g., visits, phone calls, mailed reminders) ASSIST: Identify personal barriers, strategies, problemsolving techniques and social/environmental support FIGURE 1.0 Effective self-management enables individuals with SCI to engage in meaningful activities. Photo courtesy of Rich Vanderwal and Neurocore. INFORMED SELF-MANAGEMENT | PARTICIPATION 159


P - Informed Self-Management
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