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Chronic Condition Self-Management Surveillance: What Is and What Should Be Measured?

The diagram consists of 7 boxes arranged in a vertical list with arrows pointing downward from one box to the next. Box 1 shows that 37 candidate concepts were brainstormed, and the list was reduced to 32 concepts. Boxes 2 and 3 (arranged side-by-side) indicate that an environmental scan was conducted to identify possible measures for each candidate concept; none were found. Box 3 indicates that an SMA member survey on usefulness of candidate concepts was conducted. Box 4, listed below boxes 2 and 3, indicates that the list of candidate concepts was reduced to 14. Box 5 indicates that the 14 candidate concepts were reviewed with subject matter experts, who recommended an additional 5 concepts. Box 6 indicates that a priority-setting exercise was conducted with SMA members and that 19 candidate concepts were prioritized. Box 7 indicates that 1 candidate concept per ecological level was selected for immediate development into surveillance measures.

Figure 1. Flow diagram depicting the multistep process used to identify and select high-priority concepts for development, National Council on Aging, 2013. Abbreviation: SMA, Self-Management Alliance.

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We tailored Friedan’s pyramid of public health impact to reflect SM and SMS across the 5 ecological levels (individual, healthcare system, community, policy, media). The bottom tier of the pyramid is labeled “Media: Traditional and new media messaging supporting self-management; measured through media monitoring.” The next tier up (second from the bottom of the pyramid) is labeled “Policy: Policies that can enhance self-management or the provision of self-management support.” The third tier from the bottom is labeled “Community: Community structure in place to support individual self-management.” The fourth tier from the bottom is labeled “Health systems: Interventions delivered by health care providers or by the health system to support patient self-management; measured through health system or provider measures.” The top tier is labeled “Individual self-management: Attitudes and behaviors; measured through individual report.” To the left of the pyramid, text reads “Increasing Population Impact,” beside an arrow pointing down the height of the pyramid from the top. To the right of the pyramid, text reads “Increasing Individual Effort Needed,” beside an arrow pointing up the height of the pyramid from the bottom.

Figure 2. Self-management and self-management support pyramid of public health impact. Adapted from Frieden (9).

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