Adoption of Self-Management
Interventions for Prevention and
Mary Jane Rotheram-Borus, PhDa,*, Barbara L. Ingram, PhDb,
Dallas Swendeman, PhDa, Adabel Lee, PhDa
Health care costs in the United States are reaching unprecedented heights. In 2009,
health care spending was $2.5 trillion, $8086 per person, or 17.6% of the gross
domestic product (GDP),1making it the second highest in the world. Despite this
huge financial investment, the life expectancy of people in the United States ranks
tancy for American men is 76.05 years compared with 78.89 years for Canadian men.2
In2005,43.8%oftheUScivilian, noninstitutionalizedpopulation had1ormorechronic
spending,4and 96% of Medicare annual spending is for chronic conditions.5It is esti-
mated that by 2023, there will be a 42% increase in cases of 7 major chronic diseases,
costing $4.2 trillion in treatment costs and lost economic output.6
aGlobal Center for Children and Families, Semel Institute for Neuroscience and Human
Behavior, 10920 Wilshire Boulevard, Suite 350, University of California at Los Angeles, Los
Angeles, CA 90024-6521, USA;bGraduate School of Education and Psychology, Pepperdine
University, 6100 Center Drive, Los Angeles, CA 90045, USA
* Corresponding author.
E-mail address: firstname.lastname@example.org
? Self-management ? Self-regulation ? Chronic illness ? Chronic disease
? Self-management interventions (SMI) improve health-related quality of life, reduce health
care costs, and prevent progression of chronic conditions.
? Five elements of SMIs are activating motivation, applying information, developing skills,
acquiring environmental resources, and building social support.
? These elements are as relevant to disease prevention in healthy people as they are to
management of chronic diseases.
? Development of self-management competence is conceptualized in three phases (moti-
vate, action, maintenance); interventions must be tailored to the phase.
? Delivery vehicles for SMIs range from traditional primary care settings to use of technolog-
Prim Care Clin Office Pract 39 (2012) 649–660
0095-4543/12/$ – see front matter ? 2012 Published by Elsevier Inc.