BEHAVIORAL-RESEARCH ON DIABETES AT THE OREGON RESEARCH-INSTITUTE

This article overviews the scope and progression of research on behavi oral aspects of diabetes over the past decade at the Oregon Research I nstitute. Our research team has investigated several topics including: (a) conceptual models of self-management; (b) social learning factors associated with regimen adherence; (c) individual and group-based int erventions to enhance diabetes self-management; (d) rates and determin ants of participation in diabetes education; (e) determinants of glyce mic control; and (f) patient models (beliefs) about diabetes and its t reatment. We have employed a social learning theory approach to diabet es management, and over the past decade have come to adopt a broader p ublic health perspective that addresses environmental influences on di abetes self-management at multiple levels (e.g. family, health care sy stem, community). This approach has led us to conclude that increased attention should be devoted to the most prevalent types of diabetes, t o the behavioral issues that create the most difficulty for the greate st number of patients, and to the social environment in which patients live and diabetes management education rakes place. Our research font s has evolved over time and currently emphasizes: (a) assessment and t ailoring of intervention based upon the patient's perspective; (b) pat ient-provider interactions; and (c) brief low-cost, and system-wide in terventions that can be implemented in medical office settings. Lesson s learned from this research, the potential disseminability of our fin dings, and future directions are summarized.