Exploring the meaning of the Chronic Care Model's community construct: A study of diabetes self-management support

Purpose: This research was undertaken in order to broaden our understanding of the community resources and policies construct of the Chronic Care Model (CCM), as part of a larger effort to understand how to implement the Model in several rural healthcare settings.

Setting: This study took place in 2007 in two rural counties in southwestern Pennsylvania that have high rates of type 2 diabetes. Within these two counties, four healthcare sites that provide diabetes self-management education services were involved in the recruitment of participants for this study.

Methods & Sample: The data presented here were collected from a series of individual, face-to-face and telephone interviews with twenty-nine community leaders and four focus groups with thirty-six diabetes patients. Data collection focused on gaining a better understanding of what community leaders and diabetes patients believe are the challenges to diabetes self-management and their insights about community resources needed to properly manage this disease.

Findings: The results of this research suggest that there are numerous ways that communities affect the health of people living with diabetes and their ability to self-manage their disease. These influences include the overall social, educational and economic climate which, in turn, has an impact on community knowledge of, attitudes toward and beliefs regarding diabetes. However, to date, researchers working with the CCM have not fully explored how community norms and attitudes affect diabetes health behavior nor how to measure and change community norms and attitudes regarding the prevention and management of chronic diseases such as diabetes. This information is critical to furthering our understanding of the CCM community construct as well as the design of more effective interventions based on this Model. This gap in the CCM research suggests the need to develop tool(s) designed for community leaders that complement existing tools designed from the patient and healthcare organizational perspectives that capture a community's behavioral, normative and control beliefs regarding chronic diseases like diabetes.

Contribution to knowledge: The Chronic Care Model is being used to guide the transformation of the quality of chronic illness care in the United States, yet little attention has been paid to understanding how this construct operates vis a vis other components of the Model. This study provides some important insights regarding this construct.