DECIDE Self-Management Support Program Welcomes You
Better self-management. Better outcomes.
The goal of DECIDE is to help people--ranging in age from 18 to 90 years old--learn how to change their behavior so they can better manage their chronic conditions including diabetes, high blood pressure, and chronic kidney disease. DECIDE combines brief education with problem-solving training to help people apply self-management to the context of their every day, real life challenges and barriers.
DECIDE (Decision-making Education for Choices In Diabetes Everyday) is an evidence-based self-management support program designed to improve chronic disease outcomes in high-risk and underserved populations. DECIDE originated for diabetes self-management support. DECIDE's evidence base has expanded to cardiovascular disease, chronic kidney disease, and mental health self-management.
Developed through a series of National Institutes of Health (NIH) and foundation-funded research grants, the DECIDE program is a structured, 9-module curriculum that guides participants, step-by-step, through problem-solving training for incorporating disease self-management into the context of everyday, real life barriers and challenges, enabling behavior change for improved health outcomes.
DECIDE is accessible and effective with persons with low literacy and health literacy and persons with sensory or mild cognitive impairment that can otherwise impede learning.
DECIDE is also available in audio and braille for people who are visually impaired or blind.
DECIDE is flexible for delivery in a variety of formats to suit the differing needs of organizations and individuals. You can choose a program version to fir your population's preferences and needs.
DECIDE In-Person Program
The DECIDE In-Person Program is conducted by a trained DECIDE Facilitator and can be done in group or one-on-one formats. The In-Person program is implemented over a series of 9 sessions (one session per content module) and uses a DECIDE Facilitator Guide and a hard copy DECIDE program workbook for participants. The In-Person program can be conducted in a variety of settings including health care practices, public health settings, and community settings. Facilitators complete DECIDE Facilitator Training and certification to be eligible to lead the program. See DECIDE Facilitator Training information.
DECIDE Telehealth Program
Health care and public health organizations providing telehealth and digital communication services can provide the DECIDE program in real time to program participants through this remote access. A DECIDE Facilitator conducts the series of 9 DECIDE program sessions live, with program participants accessing the program via telehealth. Telehealth has the advantages of a DECIDE In-person Program delivery, scaled to large numbers of participants who can access the sessions from convenient locations.
DECIDE Self-Directed Program
DECIDE Self-Directed Program users can navigate through the DECIDE program modules from anywhere, and at their own pace. The DECIDE curriculum is available in hard-copy workbooks that can be mailed to users completing the program. The Self-Directed Program hard-copy workbooks come with an introductory and instructional letter go guide the user. The DECIDE curriculum can also be made available as a pdf for users to access electronically and download for use. Organizations can provide links to the electronic DECIDE workbooks via an electronic health record, website, or through email.
DECIDE for Visual Impairment or Blindness
The DECIDE curriculum modules and Facilitator Guide are available in audio and in Braille for people with visual impairment or blindness and organizations serving people with visual impairment or blindness. DECIDE can be implemented using In-Person, Telehealth, or Self-Directed formats with these accessible materials.
DECIDE for Multiple Chronic Conditions
The structured program format enables DECIDE to serve effectively as a platform for patient self-management training in any chronic condition. Module 1 is self-management education tailored to the specific condition. Modules 2 – 9 provide a standardized problem-solving training approach that applies across conditions. Examples of applications of DECIDE include diabetes with cardiovascular disease, chronic kidney disease, mental health, hypertension, and primary prevention of cardiovascular disease in people at risk.
Diabetes and Cardiovascular Disease
Selected by the American Diabetes Association’s (ADA) Diabetes Self-Management Support (DSMS) Initiative as an evidence-based DSMS program, DECIDE has over 10 years of research demonstrating its effectiveness in improving diabetes and cardiovascular disease self-management and outcomes in diabetes populations. DECIDE has been used with adults ranging in age from 18 – 90 years, in urban and rural settings, clinics and communities, and representing racial and ethnic diversity. The DECIDE diabetes self-management program provides one All the Facts education module tailored to self-management of diabetes and high blood pressure and cholesterol, followed by the 8 problem-solving training modules for behavior change.
One current study, Bridge to Health, is examining the effectiveness of a community health worker (CHW) navigation intervention paired with the DECIDE self-management support program on A1C reduction among racial and ethnic minority and low-income Kaiser Permanente Northwest patients with poorly managed diabetes (Principal investigator Stephanie L. Fitzpatrick, PhD). See more at: https://research.kpchr.org/News/CHR-Stories/CHR-and-Community-Health-Workers-Building-a-Bridge-to-Health-for-Underserved-Diabetes-Patients
Chronic Kidney Disease
DECIDE has a chronic kidney disease program version, Living With Kidney Disease. This version provides an All the Facts about Chronic Kidney Disease initial self-management education module, followed by the 8 problem-solving training modules for behavior change. The chronic kidney disease self-management program is being used in the PREPARE NOW study, which is improving the health system model of care for people with chronic kidney disease as they transition through early stages of kidney disease to later stages. PREPARE NOW is implemented at Geisinger Health System, with Duke University principal investigator Dr. Ebony Boulware and Geisinger principal investigator Dr. Jamie Green. See more about the PREPARE NOW Study: http://www.kidneypreparenow.org/.
A mental health version of DECIDE provides an All the Facts self-management education module tailored to mental health symptoms and self-management knowledge, followed by the 8 problem-solving training modules for behavior change. A current study is using the DECIDE mental health program version with underserved, immigrant Latina women with a history of trauma—specifically adverse childhood experiences (ACEs). Principal investigator Dr. Carmen Alvarez is examining effectiveness of the DECIDE mental health program as an intervention to improve psychosocial well-being, self-management, and symptom reduction in Baltimore, MD.
DECIDE Facilitator Training
DECIDE Facilitator Training is required for people who will serve as DECIDE Facilitators for any of the program versions. DECIDE Facilitator Training is a 2-day class that gives instruction in what makes DECIDE work and how to deliver each of the 9 DECIDE program modules. The 2-day training is offered on a regular basis at the Johns Hopkins School of Medicine campus in Baltimore, Maryland. For organizations with large groups, on-site training can be arranged.
Health Problem-Solving Scale (HPSS, v2)
The HPSS assesses problem solving related to managing health-related challenges and problems. Survey items cover 3 areas of problem solving: problem-solving skill, problem-solving orientation, and transfer of past experience/learning. The HPSS yields a total score and subscale scores. Program participants can complete this problem-solving survey before and after the DECIDE program. The HPSS can be used with any of the DECIDE disease programs.
All the Facts About Managing Your Diabetes
This brief survey gauges participants’ knowledge of key information for diabetes self-management. Program participants can complete this knowledge survey before and after the DECIDE program. Different All the Facts Surveys are available for different DECIDE disease programs.
About the Developer
Felicia Hill-Briggs, PhD, ABPP
A clinical psychologist, behavioral scientist, and professor of medicine at Johns Hopkins University, Dr. Hill-Briggs is a nationally recognized expert in behavior change for improved population health. Her research has earned scientific awards as well as honors for improving community health and wellness. Dr. Hill-Briggs served as 2018 American Diabetes Association President, Health Care and Education. She is an elected member of the National Academy of Medicine (NAM) of the National Academies of Science, Engineering, and Medicine. Dr. Hill-Briggs has lived well with type 1 diabetes for over 40 years.
Science Underlying DECIDE Approach
Hill-Briggs F. Problem solving in diabetes self-management: a model of chronic illness self-management behavior. Ann Behavioral Med. 2003 Summer;25(3):182-93. PMID: 12763713.
Hill-Briggs F, Cooper DC, Loman K, Brancati FL, Cooper LA. A qualitative study of problem solving and diabetes control in type 2 diabetes self-management. Diabetes Educator. 2003 Nov-Dec;29(6):1018-28. Erratum in: Diabetes Educator. 2004 May-Jun;30(3):455. PMID: 14692375.
Hill-Briggs F, Gary TL, Yeh HC, Batts-Turner M, Powe NR, Saudek CD, Brancati FL. Association of social problem solving with glycemic control in a sample of urban African Americans with type 2 diabetes. J Behav Med. 2006 Feb;29(1):69-78. PMID: 16397820.
Hill-Briggs F, Gemmell L. Problem solving in diabetes self-management and control: a systematic review of the literature. Diabetes Educator. 2007 Nov-Dec;33(6):1032-50; discussion 1051-2. PMID: 18057272.
Schumann KP, Sutherland JA, Majid HM, Hill-Briggs F. Evidence-Based Behavioral Treatments for Diabetes: Problem-Solving Therapy. Diabetes Spectrum. 2011;24:64-69
Fitzpatrick SL, Schumann KP, Hill-Briggs F. Problem solving interventions for diabetes self-management and control: a systematic review of the literature. Diabetes Research and Clinical Practice. 2013 May;100(2):145-61. PMID: 23312614; PMCID: PMC3633671.
Hill-Briggs F. Problem solving. In: Mensing C, editor-in-chief. The Art and Science of Diabetes Self-Management Education: A Desk Reference for Healthcare Professionals. Chicago: American Assn Diabetes Educators; 2006:8;731-58.
DECIDE Clinical Trials
Hill-Briggs F, Lazo M, Peyrot M, Doswell A, Chang YT, Hill MN, Levine D, Wang NY, Brancati FL. Effect of problem-solving-based diabetes self-management training on diabetes control in a low income patient sample. J Gen Internal Med. 2011 Sep;26(9):972-8. PMID: 21445680; PMCID: PMC3157525.
Lilly C, Brant L, Leary J, Hill-Briggs F, Samuel-Hodge C, McMilin C, Keyserling T. Evaluation of the effectiveness of a problem-solving intervention addressing barriers to cardiovascular disease prevention behaviors in three underserved samples: Colorado, North Carolina, West Virginia, 2009. Preventing Chronic Disease. 2014;11:E32. PMID: 24602586.
Ephraim PL, Hill-Briggs F, Roter D, Bone L, Wolff J, Lewis-Boyer L, et al. Improving urban African Americans' blood pressure control through multi-level interventions in the Achieving Blood Pressure Control Together (ACT) study: A randomized clinical trial. Contemp Clin Trials. 2014;38(2):370-82. PMID: 24956323.
Fitzpatrick SL, Golden SH, Stewart K, Sutherland J, DeGross S, Brown T, Wang NY, Allen J, Cooper LA, Hill-Briggs F. Effect of DECIDE (Decision-making Education for Choices In Diabetes Everyday) Program Delivery Modalities on Clinical and Behavioral Outcomes in Urban African Americans With Type 2 Diabetes: A Randomized Trial. Diabetes Care. 2016 Dec;39(12):2149-2157. PMID: 27879359.
Majid HM, Schumann KP, Doswell A, Sutherland J, Golden SH, Stewart KJ, Hill-Briggs F. Development and evaluation of the “DECIDE to Move!” physical activity educational video. Diabetes Educator. 2012 Nov-Dec;38(6):855-9. PMID: 23042504.
DECIDE and Literacy, Functional Impairment and Disability
Hill-Briggs F, Smith AS. Evaluation of diabetes and cardiovascular disease print patient education materials for use with low-health literate populations. Diabetes Care. 2008 Apr;31(4):667-71. PMID: 18202245.
Hill-Briggs F, Schumann KP, Dike O. Five-step methodology for evaluation and adaptation of print patient health information to meet the < 5th grade readability criterion. Medical Care. 2012 Apr;50(4):294-301. PMID: 22354210; PMC ID: PMC3318988.
Hill-Briggs F, Renosky R, Lazo M, Bone L, Hill M, Levine D, Brancati FL, Peyrot M. Development and pilot evaluation of literacy-adapted diabetes and CVD education in urban, diabetic African Americans. J Gen Internal Med. 2008 Sep;23(9):1491-4. PMID: 18521688; PMCID: PMC2518002.
Hill-Briggs F, Lazo M, Renosky R, Ewing C. Usability of a diabetes and cardiovascular disease education module in an African-American, diabetic sample with physical, visual, and cognitive impairment. Rehabilitation Psychology. 2008 Feb;53(1):1-8.
Health Problem-Solving Scale
Hill-Briggs F, Gemmell L, Kulkarni B, Klick B, Brancati FL. Associations of patient health-related problem solving with disease control, emergency department visits, and hospitalizations in HIV and diabetes clinic samples. J Gen Internal Med. 2007 May;22(5):649-54. PMID: 17443373; PMCID: PMC1852911.
Hill-Briggs F, Yeh HC, Gary TL, Batts-Turner M, D'Zurilla T, Brancati FL. Diabetes problem-solving scale development in an adult, African American sample. Diabetes Educator. 2007 Mar-Apr;33(2):291-9. PMID: 17426304.
Fitzpatrick SL, Hill-Briggs F. Measuring health-related problem solving among African Americans with multiple chronic conditions: application of Rasch analysis. J Behav Med. 2015; 38:787-97. PMID: 25319236.
Shin N, Hill-Briggs F, Donovan S, Lyketsos K, Golden S. The Association of Minor and Major Depression with Health Problem-solving and Diabetes Self-care Activities in a Clinic-Based Population of Adults with Type 2 Diabetes Mellitus. J Diabetes Complications. 2017 May;31(5):880-885. PMID: 28256399.