Current evidence indicates that individuals and families who engage in self-management (SM) behaviors improve their health outcomes. While the results of these studies are promising, there is little agreement as to the critical components of SM or directions for future study. This paper offers an organized perspective of similar and divergent ideas related to SM. Unique contributions of prior work are highlighted and findings from studies are summarized. A new descriptive midrange theory, Individual and Family Self-management Theory, is presented; assumptions identified, concepts defined, and proposed relationships outlined. This theory adds to the literature on self-management by focusing on individual, dyads within the family, or the family unit as a whole; explicating process components of self-management; and proposing use of proximal and distal outcomes.The need to manage chronic conditions and to actively engage in a lifestyle that fosters health is increasingly recognized as the responsibility of the individual and their family. Health problems have shifted from acute to chronic and personal behaviors are linked to over half of chronic health problems. 1,2 Health care delivery has shifted to non-hospital venues with hospitalizations often eliminated or shortened. Criteria for hospital discharge are related to outcomes of conditions or procedures rather than the ability of patients or families to manage care. 1 It is estimated that half of all Americans are managing a serious chronic health condition at home. Over 12% of children have special health care needs and 23% of these children are significantly impacted by their condition. 3 In adults, 7% of persons between the ages of 45 and 54 and 37% of person over the age of 75 are managing three chronic conditions. 1 While the values of health promotion are increasingly realized for individuals and families, few health-promoting strategies are routinely incorporated into the delivery of health care in many settings. Individuals and families are expected to sort through the myriad of contradictory health information of varying quality and engage in behaviors promoting their health. Personal efforts to engage in healthy behaviors are often Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptNurs Outlook. Author manuscript; available in PMC 2010 July 23. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript derailed by social factors incongruent with health, 1, 4 such as neighborhoods unsafe for exercise, peer-group norms related to food choices and alcohol, and ...

An essential characteristic of advanced practice nurses is the use of theory in practice. Clinical nurse specialists apply theory in providing or directing patient care, in their work as consultants to staff nurses, and as leaders influencing and facilitating system change. Knowledge of technology and pharmacology has far outpaced knowledge of how to facilitate health behavior change, and new theories are needed to better understand how practitioners can facilitate health behavior change. In this article, the Integrated Theory of Health Behavior Change is described, and an example of its use as foundation to intervention development is presented. The Integrated Theory of Health Behavior Change suggests that health behavior change can be enhanced by fostering knowledge and beliefs, increasing self-regulation skills and abilities, and enhancing social facilitation. Engagement in selfmanagement behaviors is seen as the proximal outcome influencing the long-term distal outcome of improved health status. Person-centered interventions are directed to increasing knowledge and beliefs, self-regulation skills and abilities, and social facilitation. Using a theoretical framework improves clinical nurse specialist practice by focusing assessments, directing the use of best-practice interventions, and improving patient outcomes. Using theory fosters improved communication with other disciplines and enhances the management of complex clinical conditions by providing holistic, comprehensive care. Keywordsclinical nurse specialists; health behavior change; Integrated Theory of Health Behavior Change; self-management Personal behavior influences one's health. 1,2 Many people can improve their health by managing their chronic condition or engaging in health promotion behaviors. Persons with chronic conditions improve their health by managing specific health behaviors, a process that requires behavior change. Healthy people, as well as persons with chronic conditions, have opportunities to improve their health by regularly engaging in health promotion activities, a behavior change process similar or identical to the process used to manage chronic conditions.

Tailored interventions could be improved by (a) identifying the most salient characteristics to be tailored, (b) further delineating essential components of TIs, (c) determining the efficacy of different delivery channels, (d) determining factors that moderate effects of TIs, and (e) clarifying whether the efficacy of TIs changes over time.

Background Self-management of complex medication regimens for chronic illness is challenging for many older adults. Objectives The purpose of this study was to evaluate health status outcomes of frail older adults receiving a home-based support program that emphasized self-management of medications using both care coordination and technology. Design Randomized controlled trial with three arms and longitudinal outcome measurement. Setting Older adults having difficulty self-managing medications (N = 414) were recruited at discharge from three Medicare-certified home health care agencies in a Midwestern urban area. Methods All participants received baseline pharmacy screens. The control group received no further intervention. A team of advanced practice nurses and registered nurses coordinated care for 12 months to two intervention groups who also received either an MD.2 medication-dispensing machine or a medplanner. Health status outcomes (Geriatric Depression Scale, Mini-Mental Status Examination, Physical Performance Test, and the SF-36 Physical Component Summary and Mental Component Summary) were measured at baseline, 3, 6, 9, and 12 months. Results After covariate and baseline health status adjustment, time by group interactions for the MD.2 and medplanner groups on health status outcomes were not significant; time by group interactions were significant for medplanner and control group comparisons. Discussion Participants with care coordination had significantly better health status outcomes over time than those in the control group, but addition of the MD.2 machine to nurse care coordination did not result in better health status outcomes.