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Problem solving in diabetes self-management: A model of chronic illness self-management behavior
Abstract
Management of chronic illnesses is a significant public health concern that is made more challenging by problems of regimen adherence. Effective self-management of chronic illnesses such as diabetes requires not only technical skill to perform regimen behaviors but also problem-solving skills to manage daily barriers to regimen adherence and to make appropriate adjustments to the self-care regimen. A review of the empirical literature on the relation between problem solving and disease self-management in diabetes, a chronic illness exemplar, illuminates methodological limitations that indicate a need for a theoretical framework for problem solving applied to chronic disease self-management. A problem-solving model of chronic disease self-management is proposed, derived from theories of problem solving in cognitive psychology, educational/learning theory, and social problem solving. Four essential components of problem solving in disease self-management are identified: (a). problem-solving skill, (b). problem-solving orientation, (c). disease-specific knowledge, and (d). transfer of past experience. The model is illustrated, and empirical support for this problem-solving model in the diabetes literature is discussed. The model has utility in driving testable hypotheses regarding the relation of disease-specific problem solving to chronic illness management, in developing problem-solving assessment instruments relevant to disease self-management, and in guiding disease self-management training and interventions.
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“In addition, patients require specialized cognitive and behavioral skills to deal with their condition [4,5].”
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“Problem-solving skill was assessed with the Positive Transfer of Past Experience from the Diabetes Problem Solving Scale of Hill-Briggs [29].”
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“Better problem solving was associated with better self-care behavior but had little effect on diabetes control.(43) PST delivered by nurses in primary care improved depression outcomes for patients with depression.”
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“This reflects the problem-solving model of Hill-Briggs [35] which states that people should identify their problems and determine possible causes through seeking resources or applying the knowledge and skills they have learned.”
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“While there have been numerous advancements in the treatment of diabetes, their successful implementation places behavioral and psychological demands on persons with the disease [6,7].”
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“behavior identified problem solving as the core component (Hill-Briggs, 2003).”
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“…disease self-management have been identified, which may be manifested positively or negatively: problem-solving skills; guidance for problem-solving; specific knowledge of the disease; and capacity to use acquired experience for solving future problems (Hill-Briggs, 2003; Hill-Briggs et al., 2003).”
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“Besides technical skills, problem-solving skills are required in disease management to manage daily barriers, adhere to recommended regimens, and make appropriate adjustments [31].”
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“This result is in line with a recent conceptualization of diabetes self-management (Hill-Briggs, 2003), which suggests that we must take into account not only the role of active planning skills in diabetes self-management, but also the role of the different motivational factors that may influence…”
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“A systematic review of the literature on problem solving and diabetes self-management revealed that problem solving has generally been conceptualized in these studies as a one-dimensional, rational process, in which patients either do or do not follow steps of problem identification, generation of alternative solution…”
BackgroundSelf-citationWang, J., Zgibor, J. C., Matthews, J. T., Charron‐Prochownik, D., Sereika, S. M., & Siminerio, L. M. (2012) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721712440331 · Cited by 45
“Based on this review, Hill-Briggs proposed a model of problem solving with four essential components for problem solving in disease self-management: problem-solving skill, problem-solving orientation, disease-specific knowledge, and transfer of past experience.(14) Using SMBG results to identify hypoglycemic and hyper…”
BackgroundLin, C., Wu, C., Wu, L., Chen, H., & Chang, S. (2012) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2011.04048.x · Cited by 44
Gfeller, K. E., Driscoll, V. D., & Schwalje, A. T. (2019) · Frontiers in Neuroscience · doi:10.3389/fnins.2019.01229 · Cited by 44
“Outcomes: Data analyses informed the development of a Dynamic Problem Solving Model for Management of Music Listening Environments adapted from Hill-Briggs (2003) Problem Solving Model of Chronic Illness Self-Management.”
BackgroundMethodInfluentialInformation Technology to Support Self-Management in Chronic Care
Solomon, M. R. (2008) · Disease Management & Health Outcomes · doi:10.2165/0115677-200816060-00004 · Cited by 44
Development and process evaluation of an Internet-based physical activity behaviour change program
Steele, R. M., Mummery, K. W., & Dwyer, T. (2007) · Patient Education and Counseling · doi:10.1016/j.pec.2007.02.013 · Cited by 42
Moayed, M. S., Ebadi, A., Khodaveisi, M., Toosi, M. N., Soltanian, A. R., & Khatiban, M. (2018) · Patient Preference and Adherence · doi:10.2147/ppa.s180341 · Cited by 46
“In the self-management of chronic disease, problem-solving compromised four components such as problem-solving skill, problem-solving orientation, disease-specific knowledge, and transfer of past experiences.(38) Similarly, the participants perceived the necessity of transfer of past experiences to the altered health…”
BackgroundPichon, A., Schiffer, K., Horan, E. N., Massey, B., Henry, S. B., Mamykina, L., & Elhadad, N. (2021) · Proceedings of the ACM on Human-Computer Interaction · doi:10.1145/3434170 · Cited by 40
“Patients engage in problem-solving to transfer insights from past experiences onto current self-management situations [53].”
BackgroundYap, J. M., Tantono, N., Wu, V. X., & Klainin‐Yobas, P. (2021) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x211058329 · Cited by 54
“…of problem-solving in chronic illness self-management, problem-solving skill is one of the components for effective self-management of diabetes 77 and self-management behaviours improve health outcomes including DD. 78 Furthermore, technology-delivered interventions allowed access to ongoing…”
BackgroundEvidence-Based Behavioral Treatments for Diabetes: Problem-Solving Therapy
Schumann, K. P., Sutherland, J. A., Majid, H. M., & Hill‐Briggs, F. (2011) · Diabetes Spectrum · doi:10.2337/diaspect.24.2.64 · Cited by 39
Self-citationEphraim, P. L., Hill‐Briggs, F., ROTER, D. L., Bone, L., Wolff, J. L., Lewis-Boyér, L., Levine, D. M., Aboumatar, H. J., Cooper, L. A., Fitzpatrick, S. J., et al. (2014) · Contemporary Clinical Trials · doi:10.1016/j.cct.2014.06.009 · Cited by 35
“Psychological Correlates—We will assess patient participants’ decision self-efficacy [67–69], problem-solving skills [70, 71], patient activation [72], depression [73], perceived stress [74], resilience [75, 76], and history of traumatic events [77] via telephone questionnaire at baseline, 4 months and 12 months follo…”
Self-citationCole-Lewis, H. J., Smaldone, A. M., Davidson, P. G., Kukafka, R., Tobin, J. N., Cassells, A. N., Mynatt, E. D., Hripcsak, G. M., & Mamykina, L. (2015) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2015.08.003 · Cited by 37
“Three of these categories (nutrition, physical activity, and medication) are consistent with the behaviors required for problem-solving in diabetes management proposed by other researchers [21].”
BackgroundMethodResultInfluentialGreen, J. A., Ephraim, P. L., Hill‐Briggs, F., Browne, T. A., Strigo, T. S., Hauer, C., Stametz, R. A., Darer, J. D., Patel, U. D., Lang‐Lindsey, K., et al. (2018) · Contemporary Clinical Trials · doi:10.1016/j.cct.2018.09.004 · Cited by 36
“Kidney Transitions Specialists provide and facilitate an individually tailored, multi-component intervention featuring evidence-based [47-50] patient support programs to”
Self-citationKörver, S., Geurtsen, G. J., Hollak, C. E. M., van Schaik, I. N., Longo, M. G. F., Lima, M. R., Vedolin, L., Dijkgraaf, M. G. W., & Langeveld, M. (2020) · Orphanet Journal of Rare Diseases · doi:10.1186/s13023-020-1307-y · Cited by 33
“lifestyle adjustments, scheduling hospital appointments) improves self-management in for example type 2 diabetes patients [30].”
BackgroundVenditti, E. M., Tan, K., CHANG, N. T., Laffel, L. M., McGinley, G., Miranda, N., Tryggestad, J. B., Walders‐Abramson, N., Yasuda, P. M., & Delahanty, L. M. (2018) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2018.02.001 · Cited by 34
“Behavioral problem-solving interventions that train individuals to develop personalized strategies in response to environmental cues are also worthwhile and have been integral to work in adults with Type 2 diabetes[27].”
BackgroundComellas, M., Walker, E. A., Movsas, S., Merkin, S., Zonszein, J., & Strelnick, H. (2009) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721709354606 · Cited by 32
“Problem solving is characterized as a technique used by people to identify and overcome barriers to achieving a stated goal, such as being physically active, eating a healthy diet, or medication adherence.(11,12) The CHPs first learned and subsequently presented a model of problem solving used in the Diabetes Preventi…”
BackgroundHill‐Briggs, F., Renosky, R. J., Lazo, M., Bone, L., Hill, M., Levine, D. M., Brancati, F. L., & Peyrot, M. F. (2008) · Journal of General Internal Medicine · doi:10.1007/s11606-008-0679-9 · Cited by 31
Self-citationAnderson, D., Horton, C. K., O'Toole, M. L., Brownson, C. A., Fazzone, P., & Fisher, E. B. (2007) · Diabetes Spectrum · doi:10.2337/diaspect.20.1.10 · Cited by 30
Lukewich, J., Mann, E. G., VanDenKerkhof, E. G., & Tranmer, J. E. (2015) · Journal of Advanced Nursing · doi:10.1111/jan.12717 · Cited by 29
Practices and Attitudes That Enhance Music Engagement of Adult Cochlear Implant Users
Gfeller, K. E., Mallalieu, R., Mansouri, A., McCormick, G., O’Connell, R. B., Spinowitz, J., & Turner, B. G. (2019) · Frontiers in Neuroscience · doi:10.3389/fnins.2019.01368 · Cited by 29
Gary‐Webb, T. L., Hill‐Briggs, F., Batts-Turner, M. L., & Brancati, F. L. (2005) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721705282254 · Cited by 27
Self-citationSelf-management of chronic conditions: the legacy of Sir William Osler
Creer, T. L., & Holroyd, K. A. (2006) · Chronic Illness · doi:10.1177/17423953060020010501 · Cited by 27
Living with diabetes—Development of learning patterns over a 3-year period
Kneck, Å., Fagerberg, I., Eriksson, L. E., & Lundman, B. M. (2014) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.3402/qhw.v9.24375 · Cited by 26
“At the same time, participants in Pattern II experienced that learning is not easy, instead it involves a lot of effort and also includes making painful mistakes, described by Hill-Briggs (2003) as essential for the management of daily barriers when living with diabetes.”
BackgroundA study of a pre-operative intervention in patients with diabetes undergoing cardiac surgery
Lee, G., Wyatt, S., Topliss, D. J., Walker, K. Z., & Stoney, R. (2013) · Collegian Journal of the Royal College of Nursing Australia · doi:10.1016/j.colegn.2013.06.001 · Cited by 25
Diabetes Problem-Solving Scale Development in an Adult, African American Sample
Hill‐Briggs, F., Yeh, H., Gary‐Webb, T. L., Batts-Turner, M. L., D’Zurilla, T. J., & Brancati, F. L. (2007) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721707299267 · Cited by 26
Self-citationLesley, M. L. (2006) · Patient Education and Counseling · doi:10.1016/j.pec.2006.07.001 · Cited by 22
“The positive findings add to evidence from earlier dietary problem solving research that included more intensive interventions [24,25], reviews of other self-management education programs in which problem solving skill was a central concept [31–33], findings from the U.”
ResultAldemir, İ. D., Doğulu, C., & Bozo, Ö. (2019) · Current Psychology · doi:10.1007/s12144-019-00309-7 · Cited by 23
“…awareness of attention, environmental cues, and inner experiences (Chatzisarantis and Hagger 2007), individual differences in executive functioning (Hall et al. 2008), coping planning (Scholz et al. 2008), and problem solving (Hill-Briggs 2003) may influence adherence levels to diabetes regimen.”
BackgroundYu, J., Xu, T., James, R. A., Lu, W., & Hoffman, J. E. (2020) · JMIR Diabetes · doi:10.2196/20888 · Cited by 24
“Examples include Funnell et al’s [10] empowerment-based program, Hill-Briggs et al’s [11] problem-solving approach, Lorig’s [12] Chronic Disease Self-Management Program, and Surwit’s [13] stress management program.”
Selbstmanagementförderung bei chronischer Krankheit: Geschichte, Konzept und Herausforderungen
Haslbeck, J. W., & Schaeffer, D. (2007) · Pflege · doi:10.1024/1012-5302.20.2.82 · Cited by 22
The introduction of self-management in type 2 diabetes care: A narrative review
Tol, A., & Baghbanian, A. (2012) · Journal of Education and Health Promotion · doi:10.4103/2277-9531.102048 · Cited by 28
“Curative and medical approaches towards dealing with patients and diseases have been widely replaced by preventive and participatory approaches where patients’ role is critical to managing their care services.[21] The term ‘curative model’ and similar concepts such as ‘cure-oriented medicine’-which are widely used in…”
BackgroundMethodInfluential
Metadata
- Authors
- Hill-Briggs, F.
- Venue
- Annals of Behavioral Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2003-06
- Volume
- 25
- Issue
- 3
- Pages
- 182-193
- ISSN
- 0742-5554 (ISSN-L)
- 0883-6612
- 1532-4796
- OpenAlex
- W2044182956
- Cited by
- 241
- References
- 71
- Citations by year
- 2026: 8 · 2025: 9 · 2024: 5 · 2023: 11 · 2022: 9 · 2021: 13 · 2020: 10 · 2019: 14 · 2018: 14 · 2017: 6 · 2016: 7 · 2015: 10 · 2014: 19 · 2013: 8 · 2012: 11
- FWCI
- 1.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Behavioral Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Public Health Service (R01-48117-03S1)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Social Sciences › Psychology › Applied Psychology › Problem Solving Skills Development
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Keywords
- diabetes self-management, problem solving, chronic disease self-management, medication adherence, problem-solving model, social problem solving, cognitive psychology, disease-specific knowledge, self-management education
- MeSH terms
- Attitude to Health, Chronic Disease, Humans, Problem Solving, Psychological Theory, Self Care, Sick Role
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