Outcomes in this theory are both proximal and distal. The proximal outcome is actual engagement in self-management behaviors specific to a condition or health behavior. Distal outcomes refer to the long-term impact of personal behavior on health status. Failure to engage in healthy behaviors may result in premature onset of disease conditions. Distal outcomes are related, in part, to successful achievement of proximal outcomes. Although achievement of distal outcomes provides data about the effectiveness of the intervention, these outcomes are generally slow to be realized. Measurement of proximal outcomes is critical to evaluate whether people have made and are maintaining change in their health behavior.