Patient Education In the Department of Medicine
Steps to Healthier Living trademark

Better Choices, Better Health®- Diabetes
or Healthier Living With Diabetes
(Internet Diabetes Self-Management Program)


Launch your Digital Self-Management Program! Canary Health can deliver digital health self-management programs to your populations. To learn more, email Canary Health has licensed all online Stanford Self-Management Programs.

Better Choices, Better Health®- Diabetes, previously named Self-Management @ Stanford Healthier Living with Diabetes, is an online workshop given on the Internet. It is based on the earlier Healthier Living With Ongoing Health Problems online program and the community-based Diabetes Self-Management Program. Groups of about 24 people with type 2 diabetes participate together. Workshops are facilitated by two trained facilitators, one or both of whom are peers with diabetes. Topics covered include: 1) healthy eating and menu planning, 2) managing blood glucose, 3) techniques to deal with problems such as fatigue, frustration and isolation, 4) appropriate exercise for managing blood glucose and for maintaining and improving strength, flexibility, and endurance, 5) appropriate use of medications, 6) communicating effectively with family, friends, and health professionals, 7) goal-setting, and, 8) disease-related problem solving.

Each workshop is 6 weeks with new lessons each week. Participants are asked to log on at their convenience 2-3 times each week for a total of 1-2 hours. There are no requirements that participants log in at the same time. Each participant in the workshop receives a copy of the companion book, Living a Healthy Life with Chronic Conditions, 4th Edition.

The process of the online workshop is based on the experience of the investigators and others with self-efficacy, the confidence one has that he or she can master a new skill or affect one's own health. The content of the workshop was the result of focus groups with people with diabetes, in which the participants discussed which content areas were the most important to them, as well as from interviews with diabetes educators and physicians.

Does the Program replace existing programs and treatments?

The online workshop will not conflict with existing programs or treatment. It is designed to enhance regular treatment and disease-specific diabetes education. In addition, many people with diabetes have additional chronic conditions . The program is especially helpful for these people, as it gives them the skills to coordinate all the things needed to manage their health, as well as to help them keep active in their lives.

How was the Program developed?

The workshop is the online version of the community-based Diabetes Self-Management Program (DSMP), which was developed and and evaluated as part of a randomized, controlled study. The research study wass funded by the National Institutes of Health and the Robert Wood Johnson Foundation. It was based on our experience with the Healthier Living With Ongoing Health Problems online workshop.

How was the online program evaluated?

We recruited about 760 adult study participants in 2006-2007, which included 110 American Indian/Alaska Natives. All participants had a diagnosis of type 2 diabetes and lived in the United States. Qualified participants were randomly assigned to either participate in the workshop or to a control group. The control group received gift certificates with each data collection point and the book used in the workshop at the end of their participation. Both groups complete 4 home blood tests for A1C and online questionnaires about their health status, health care utilization, self-efficacy and self-management behaviors over a 2-year period.

What were the results?

At 6 months, A1C, patient activation, and self-efficacy were improved for program participants compared with usual care control subjects. There were no changes in other health or behavioral indicators. The American Indian/Alaska Native program participants demonstrated improvements in health distress and activity limitation compared with usual-care control subjects. The subgroup with initial A1C greater than 7 demonstrated stronger improvement in A1C. At 18 months, self-efficacy and patient activation were improved for program participants. A1C was not measured at 18 months.

Is the program being offered?

The online diabetes program is licensed to the National Council on Aging (NCOA). See the NCOA website for more information. If you are a participant and would like to take part in a workshop, please email


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