Figure 6.4. Overcoming barriers to healthy eating communities have available a series of free or low-cost support or reinforcement activities (e.g. ADA meetings, hospital or HMO lectures or education programmes, newsletters) that can extend the motivation patients receive during office visits. Anderson and Funnell14 have provided a useful discus sion and examples of community support options to reinforce physician messages about diabetes management, and Anderson et al.70 have described a series of publicly available, camera-ready, two-page, single-issue newsletters that can be sent to patients to reinforce a selected goal.

Self-management activities do not occur in a vacuum, but rather in a social context. If maintenance of self-management is to be expected, follow-up support must be arranged in the form of family and community social support, and follow-up contacts with members of the health care team38. The flow chart (Figure 6.5) and text below address how these suggestions might work into the flow of a busy practice.

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