Principle 1. Brief Targeted Assessment to Guide SMS:
Assessment of clinical severity, functional status, patients’
problems and goals, self-management behaviors, and barriers
to self-management is integral to SMS. Direct evidence for
assessment is sparse because it has not been isolated as an intervention.
However, assessment of needs, preferences, behaviors,
readiness, and barriers to self-management is a first step in all
SMS interventions and assessment, and if done appropriately, is
a way of engaging patients in their own care. It is not possible
to match a patient with an intervention on the basis of preferences,
readiness, or current behavior without assessment. These
assessments then direct patient-specific behavior change interventions,
collaborative care planning, and problem solving.10 A
review of the effect of self-help materials for smoking cessation15
showed that interventions with assessment-based tailoring of
materials to the individual were more effective than nontailored
interventions. Strongest evidence of the value of assessment
comes from the Public Health Service Tobacco Treatment
Guideline,16 which found that assessment of smoking status
(through a reminder) actually increased rates of clinician
intervention and doubled cessation rates. Ebrahim et al.17
found that for secondary prevention programs following
myocardial infarction, assessment and targeting interventions
toward lifestyle risk factors resulted in significant benefits to
patients