By including reduction of health risks and preventative
maintenance of chronic conditions in the definition of selfmanagement,
we broadened the focus of the evidence from
disease-specific self-management to alcohol, smoking, and
related lifestyle domains, where much of the research on effective
interventions to change behavior has been directed. We
acknowledge the challenges in implementing SMS in routine
practice and provide an example of how the principles may
inform practice change by linking the principles to three phases
of an enhanced primary care visit: (1) enhanced previsit
assessment, (2) focused clinical encounter, and (3) expanded
postvisit options. Finally, we comment on the need for more
evidence of the cost-effectiveness of SMS interventions.