Behavioral research on diabetes at the Oregon Research Institute.

This article overviews the scope and progression of research on behavioral aspects of diabetes over the past decade at the Oregon Research Institute. 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 interventions to enhance diabetes self-management; (d) rates and determinants of participation in diabetes education; (e) determinants of glycemic control; and (f) patient models (beliefs) about diabetes and its treatment.We have employed a social learning theory approach to diabetes management, and over the past decade have come to adopt a broader public health perspective that addresses environmental influences on diabetes self-management at multiple levels (e.g. family, health care system, community). This approach has led us to conclude that increased attention should be devoted to the most prevalent types of diabetes, to the behavioral issues that create the most difficulty for the greatest number of patients, and to the social environment in which patients live and diabetes management education takes place. Our research focus has evolved over time and currently emphasizes: (a) assessment and tailoring of intervention based upon the patient's perspective; (b) patient-provider interactions; and (c) brief, low-cost, and system-wide interventions that can be implemented in medical office settings. Lessons learned from this research, the potential disseminability of our findings, and future directions are summarized.