Principle 5. Collaborative Problem Solving: Collaborative
problem solving improves self-management and outcomes.
Problem solving consists of a set of steps whereby individuals
define a problem, brainstorm possible solutions, chose a strategy,
try it, evaluate the response, and repeat the process. Problem
solving therapy (PST) teaches patients how to use problem
solving to identify strategies for achieving successful adoption
of new behaviors and for overcoming barriers to change38 and
enables the translation of techniques for self-management into
specific plans and behaviors.39 A frequently cited intervention,
the arthritis self-management program, includes problemsolving
training.40 This program resulted in improvements in
pain of 20% compared with control groups, sustained for four
years after the course. Lorig et al. emphasize that it is important
to help people learn the skill of problem solving (as opposed to
having a clinician do the problem solving for them) so they
develop the capacity to address barriers themselves. A systematic
review of problem solving in adults with diabetes showed
that there was consistent evidence of an association between
problem solving and A1C levels mediated through improvements
in dietary behaviors.41 Problem solving was one of a combination
of strategies in successful programs focusing on
lifestyle change for diabetes.42 Better problem solving was associated
with better self-care behavior but had little effect on diabetes
control.43