Patient Self-Management Pioneer

By the time Kate Lorig, RN, DrPH, finished nursing school at Boston University in 1964, she knew that she would pursue community health nursing. “Basically,” she says, “I didn’t like hospitals! I liked meeting people and talking to them in their homes.” And indeed, Dr. Lorig’s initial attraction to community health nursing has informed her life’s work—the fruits of which now have a worldwide reach.

As a colleague and collaborator with her mentor, Halsted Holman, MD—the Guggenhime Professor of Medicine, Emeritus, at Stanford Medical School in Stanford, Calif.—Dr. Lorig has become a tireless champion in advancing the concept of efficacious patient self-management. She is currently director of Stanford University School of Medicine’s Patient Education Research Center. Through successful research collaborations and Dr. Lorig’s dedication to disseminating knowledge, the first Arthritis Self-Management Program became the prototype for additional self-management programs in chronic disease, HIV, back pain, and diabetes. The arthritis, chronic disease, and diabetes programs are replicated in Spanish, and several programs are now available online through Stanford University and through distribution partnerships with other agencies.

Mentors Along the Way

The idea of layperson-led patient education was considered radical when work began on the foundational Arthritis Self-Management Program in the late 1970s. But Dr. Lorig had already seen the effectiveness of this approach in other settings. As a public health nurse during a stint with the Peace Corps in Chile in the mid-1960s, she helped set up a public health nursing service for Valdivia, a city of 100,000 people. Workers with 10 to 12 years of education and one year of specialized, focused training did maternal and child health, delivered anesthesia, or worked in pharmacies. Back in the United States, she volunteered for a year at the Haight Ashbury Free Clinic, then moved to the Alviso Family Health Center in Alviso, Calif., where she worked as a healthcare curriculum developer and trained community health workers. At the Alviso Family Health Center, she was able to further her interest, sparked during her tour with the Peace Corps, in working with underserved Hispanic communities. Her position as professional coordinator for the International Confederation of Midwives entailed more travel, for organizing family planning conferences in Africa and Latin America.

In each of these settings, Dr. Lorig was inspired by the willingness of her colleagues to try new things. It was also historically a much different time. The Kennedy years, the War on Poverty, the movement to examine healthcare inequities, and the shift to community-based education all contributed, recalls Dr. Lorig, to a time of tremendous innovation. “I sometimes feel sorry that young people today don’t have the same opportunities we had” to be as experimental, she says.