Release Date:  June 22, 2000

PA NUMBER:  PA-00-109

National Institute of Nursing Research
National Heart, Lung, and Blood Institute
National Institute on Aging
National Institute of Arthritis and Musculoskeletal and Skin Diseases
National Institute of Child Health and Human Development
National Institute of Diabetes and Digestive and Kidney Diseases
National Institute of Mental Health
National Institute of Neurological Disorders and Stroke



The purpose of this Program Announcement (PA) is to solicit applications to 
expand research on established self-management interventions to multiple 
chronic diseases across the life-course. Interventions aimed at chronic 
disease self-management are numerous and many are well described in the 
literature. They are often presented as specific to a particular chronic 
disease. This PA encourages applicants to investigate the applicability of 
effective self-management interventions to a broader spectrum of chronic 
diseases. Chronic disease, for this announcement, is defined as illnesses that 
are prolonged, are rarely cured completely, and require self-management 
behaviors by affected individuals and/or their caretakers.


The Public Health Service (PHS) is committed to achieving the health promotion 
and disease prevention objectives of "Healthy People 2010," a PHS led national 
activity for setting priority areas.  This PA, Self-Management Strategies 
Across Chronic Diseases, is related to one or more of the priority areas.  
Potential applicants may obtain a copy of "Healthy People 2010" at


Applications may be submitted by domestic and foreign, for-profit and non-
profit organizations, public and private, such as universities, colleges, 
hospitals, laboratories, units of State and local governments, and eligible 
agencies of the Federal government.  Racial/ethnic minority individuals, 
women, and persons with disabilities are encouraged to apply as principal 


This PA will use the National Institutes of Health (NIH) Research Project 
Grant (R01) award mechanism.  Responsibility for the planning, direction, and 
execution of the proposed project will be solely that of the applicant.  The 
total project period for an application submitted in response to this PA may 
not exceed 5 years.

Specific application instructions have been modified to reflect "MODULAR 
GRANT" and "JUST-IN-TIME" streamlining efforts being examined by the NIH. 
Complete and detailed instructions and information on Modular Grant 
applications can be found at


Self-management behavior, to some degree, has been an expectation for 
individuals with a chronic disease for much of the past century. The concept 
of self-management and its practice, however, is changing. A more proactive 
self-management role is being promoted rather than a health care provider 
giving instructions and hoping the patient will adhere to them. Individuals 
with a chronic disease are being involved in a more active role.  Effective 
self-management today includes a broad range of health, lifestyle, and self-
assessment and treatment behaviors by the individual, often with assistance 
and support of others. The promotion and maintenance of a healthful and 
satisfying life, in the presence of chronic disease, requires individuals to 
assume both leadership and partnership roles with health care providers. 

The Centers for Disease Control and Prevention (CDC) reports that nearly three 
quarters of adults age 65 years and older have one or more chronic illnesses, 
and nearly half report two or more. With an aging population, chronic diseases 
will increase proportionately. Children and young people who have a chronic 
disease can expect to live longer and, therefore, will have a need to manage 
their health condition(s) over a longer life span than in the past. With an 
increasing life span, older individuals will require more health services 
longer for chronic health conditions. Medical care costs for people with 
chronic diseases today are more than $400 billion annually, accounting for 
more than 60% of total medical care expenditures. Furthermore, the CDC reports 
that 7 of every 10 deaths in the U.S. are due to chronic diseases. 

The cost of health care for individuals with chronic illnesses does not 
typically consider the personal, occupational, and financial costs related to 
self-management or disabilities. Nor does it account for the social and 
psychological burdens placed on the individual, the family, and society as a 
whole by the 90 million Americans with one or more chronic diseases. The 
personal and social costs can be affected by improving and supporting healthy 
lifestyle and self management behaviors of those affected by chronic disease. 

Researchers have developed many effective interventions for chronic disease 
self-management. Many of these interventions, however, were developed in one 
chronic disease population and not adequately tested in other chronic disease 
populations.  Studies have shown, for example, that interventions involving 
social support, provider-client interactional style, improved self-efficacy, 
problem solving or coping skills, and certain follow-up activities have a 
positive impact on self-management and health outcomes in specific chronic 
diseases. This affects both affected individuals and significant others. 
Caregiving knowledge and expertise relevant to diabetes management are often 
critical for family members and others assisting dependent children and 
elders. Even without a caregiving component, families and significant others 
are affected by a member’s chronic condition and its lifestyle and care 

There is growing interest in the public health arena and across disciplines in 
interventions that can be applied across chronic diseases. This initiative to 
extend current research to test the effectiveness of self-management 
interventions across chronic diseases is a logical next step. Standard 
interventions requiring minimal adaptation to a particular disease have the 
potential to be more cost effective and less complicated to translate into 
practice than those requiring extensive adaptation to each health condition. 
Effective self-management interventions for identified chronic diseases and 
populations are the expected outcomes of such research. The study of 
interventions with a high potential for effectiveness and efficacy across 
several chronic diseases may increase the generalizability of findings and 
maximize the effectiveness of research and health care dollars. 


This Program Announcement solicits proposals to further test established 
interventions for self-management in new populations and across chronic 
diseases not previously tested, or adequately tested, for the intervention. 
There is a particular interest in extending previously validated interventions 
to different chronic disease populations. All age and ethnic groups are of 
interest. Examples of approaches include (a) comparing intervention strategies 
across two or more groups, each with a different chronic disease or (b)  
comparing intervention strategies in a single population with two or more 
chronic diseases. Methodology should include common outcome measures for the 
intervention across chronic diseases as well as disease-specific outcome 

The following research topics are provided as examples that would extend the 
current knowledge base.  They are not listed in any priority order and are not 
intended to be inclusive or restrictive.

o  Investigate intervention strategies that promote chronic illness self-
management across chronic diseases in which they have not been adequately or 
previously tested;
o  Test intervention strategies that promote self-monitoring, health 
behaviors, problem solving, and decision making across chronic diseases;
o  Develop standard approaches to promotion and support of self-management 
across chronic disease conditions;
o  Determine the influence of established approaches to self-management across 
chronic diseases (examples: improved self-efficacy, cognitive strategies, 
social support, coping skills, provider-client partnership); 
o  Examine the influence of quality of life, burden of care, culture, 
ethnicity, age, family, or socioeconomic status across chronic diseases on 
o  Determine whether age-, gender-, and ethnically-related motivational 
factors are associated with improved self-management of chronic diseases in 
o  Investigate how the multiple co-morbidities and disabilities associated in 
the most advanced years affect the types of self-management strategies chosen 
as well as the effectiveness of different approaches;
o  Test evidence-based clinical guidelines across settings for different age, 
ethnic, or socioeconomic groups across chronic diseases; and 
o  Determine provider roles/approaches and care coordination systems that are 
most effective in providing seamless, continuous care that promotes effective 
self-management across chronic diseases.
NHLBI: Self-management strategies are applicable to a number of blood 
diseases. For example, self monitoring of coagulation status is now possible 
with new technologies leading to more precise adjustment of medications. Self-
monitoring also allows home therapy of patients with deep vein thrombosis 
utilizing low molecular weight heparin.  Patients are increasingly encouraged 
to adjust and administer treatments such as iron chelation therapy for those 
with secondary iron overload secondary to chronic transfusion, and pain 
medication for those with sickle cell disease and recurrent crises. The 
patient with hemophilia can now administer clotting factor at home 
substantially reducing hospitalization and time lost from school and work.  
New communication technologies that link health care providers with patients 
also facilitate increasing patient empowerment to monitor and manage their own 
chronic blood disease.  Innovative proposals to use self-management strategies 
to reduce healthcare disparities are especially encouraged.

NIA: NIA is interested in understanding biological, behavioral, and social 
factors that affect the aging process and the health and quality of life of 
older persons. We are especially interested in the interaction of disease and 
care factors with proposed studies explicitly examining the role of aging and 
life-course factors in disease onset, progression and/or management. While all 
age-related chronic conditions are of interest to NIA, we encourage research 
that investigates multiple morbidities common in old age. Self-management 
issues associated with Alzheimer’s disease and related disorders are of 
particular interest.

NIAMS:  The National Institute of Arthritis and Musculoskeletal and Skin 
Diseases (NIAMS) is interested in the design, development and testing of new 
and improved self-management programs for rheumatic and related diseases such 
as arthritis, lupus, scleroderma and fibromyalgia, disorders of the 
musculoskeletal system, and diseases of muscle, bone, and skin.  Within these 
areas, the Institute encourages the development of self-management programs 
that target women, children and disproportionally affected patient populations 

NIMH:  The NIMH encourages applications that explicitly and centrally explore 
the role of mental disorders/symptoms/related disability.  We are particularly 
interested in studies on modifiable risk and protective processes and the 
development and initial testing of new interventions.  The interventions may 
be pharmacologic, behavioral, or psychosocial.

NINDS:  The National Institute of Neurological Disorders and Stroke (NINDS) is 
interested in the development and evaluation of interventions for initiation 
and maintenance of self-management activities applicable to patients with 
chronic neurological disorders (e.g., epilepsy) and stroke.  Self-management 
interventions for patients with neurological disorders and stroke require 
special adaptation to reflect psychiatric co-morbidities and cognitive 
deficits in these patients.  Interventions for stroke patients need to address 
multiple self-management activities, including drug regimens and lifestyle 

It is the policy of the NIH that women and members of minority groups and 
their subpopulations must be included in all NIH supported biomedical and 
behavioral research projects involving human subjects, unless a clear and 
compelling rationale and justification are provided that inclusion is 
inappropriate with respect to the health of the subjects or the purpose of the 
research.  This policy results from the NIH Revitalization Act of 1993 
(Section 492B of Public Law 103-43).

All investigators proposing research involving human subjects should read the 
"NIH Guidelines For Inclusion of Women and Minorities as Subjects in Clinical 
Research," which have been published in the Federal Register of March 28, 1994 
(FR 59 14508-14513) and in the NIH Guide for Grants and Contracts, Vol. 23, 
No. 11, March 18, 1994 and is available on the web at the following URL 

It is the policy of NIH that children (i.e., individuals under the age of 21) 
must be included in all human subjects research, conducted or supported by the 
NIH, unless there are scientific and ethical reasons not to include them.  
This policy applies to all initial (Type 1) applications submitted for receipt 
dates after October 1, 1998.

All investigators proposing research involving human subjects should read the 
"NIH Policy and Guidelines on the Inclusion of Children as Participants in 
Research Involving Human Subjects" that was published in the NIH Guide for 
Grants and Contracts, March 6, 1998, and is available at the following URL 

Investigators also may obtain copies of these policies from the program staff 
listed under INQUIRIES.  Program staff may also provide additional relevant 
information concerning the policy.


Applications received in response to this program announcement are expected to
focus on scientific issues related to aging and to aging-related aspects of
disease. In describing the plan to recruit human subjects, investigators may 
cite a focus on aging or on aging-related aspects of disease as the 
justification for why children will be excluded. In this regard, applicants 
may use Justification 1, the research topic to be studied is irrelevant to 
children, from the policy announcement.


All applications and proposals for NIH funding must be self-contained within 
specified page limitations. Unless otherwise specified in an NIH solicitation, 
internet addresses (URLs) should not be used to provide information necessary 
to the review because reviewers are under no obligation to view the Internet 
sites. Reviewers are cautioned that their anonymity may be compromised when 
they directly access an Internet site.


Applications are to be submitted on the grant application form PHS 398 (rev. 
4/98) and will be accepted at the standard application deadlines as indicated 
in the application kit.  Application kits are available at most institutional 
offices of sponsored research and may be obtained from the Division of 
Extramural Outreach and Information Resources, National Institutes of Health, 
6701 Rockledge Drive, MSC 7910, Bethesda, MD 20892-7910, telephone 301/710-0267, email:

Applicants planning to submit an investigator-initiated new (type 1), 
competing continuation (type 2), competing supplement, or any amended/revised 
version of the preceding grant application types requesting $500,000 or more 
in direct costs for any year are advised that he or she must contact the 
Institute or Center (IC) program staff before submitting the application, 
i.e., as plans for the study are being developed.  Furthermore, the 
application must obtain agreement from the IC staff that the IC will accept 
the application for consideration for award.  Finally, the applicant must 
identify, in a cover letter sent with the application, the staff member and 
Institute or Center who agreed to accept assignment of the application.  

This policy requires an applicant to obtain agreement for acceptance of both 
any such application and any such subsequent amendment.  Refer to the NIH 
Guide for Grants and Contracts, March 20, 1998 at

The modular grant concept establishes specific modules in which direct costs 
may be requested as well as a maximum level for requested budgets. Only 
limited budgetary information is required under this approach.  The 
just-in-time concept allows applicants to submit certain information only when 
there is a possibility for an award. It is anticipated that these changes will 
reduce the administrative burden for the applicants, reviewers and Institute 
staff.  The research grant application form PHS 398 (rev. 4/98) is to be used 
in applying for these grants, with the modifications noted below.



Modular Grant applications will request direct costs in $25,000 modules, up to 
a total direct cost request of $250,000 per year. (Applications that request 
more than $250,000 direct costs in any year must follow the traditional PHS 
398 application instructions.)  The total direct costs must be requested  in 
accordance with the  program guidelines and  the modifications made to the 
standard  PHS 398 application  instructions described below:

PHS 398

o FACE PAGE: Items 7a and 7b should be completed, indicating Direct Costs (in 
$25,000 increments up to a maximum of $250,000) and Total Costs [Modular Total 
Direct plus Facilities and Administrative  (F&A) costs] for the initial budget 
period Items 8a and 8b should be completed indicating the Direct and Total 
Costs for the entire proposed period of support.

of the PHS 398. It is not required and will not be accepted with the 

categorical budget table on Form Page 5 of the PHS 398. It is not required and 
will not be accepted with the application.

o NARRATIVE BUDGET JUSTIFICATION - Prepare a Modular Grant Budget Narrative 
page. (See for sample 
pages.) At the top of the page, enter the total direct costs requested for 
each year.  This is not a Form page.

o Under Personnel, List key project personnel, including their names, percent 
of effort, and roles on the project. No individual salary information should 
be provided. However, the applicant should use the NIH appropriation language  
salary cap and the NIH policy for graduate student compensation in developing 
the budget request.

For Consortium/Contractual costs, provide an estimate of total costs (direct 
plus facilities and administrative) for each year, each rounded to the nearest 
$1,000. List the individuals/organizations with whom consortium or contractual 
arrangements have been made, the percent effort of key personnel, and the role 
on the project. Indicate whether the collaborating institution is foreign or 
domestic. The total cost for a consortium/contractual arrangement is included 
in the overall requested modular direct cost amount.  Include the Letter of 
Intent to establish a consortium.

Provide an additional narrative budget justification for any variation in the 
number of modules requested.

o BIOGRAPHICAL SKETCH - The Biographical Sketch provides information used by  
reviewers in the assessment of each individual's qualifications for a specific 
role in the proposed project, as well as to evaluate the overall 
qualifications of the research team. A biographical sketch is required for all 
key personnel, following the instructions below. No more than three pages may 
be used for each person. A sample biographical sketch may be viewed at:

- Complete the educational block at the top of the form page;
- List position(s) and any honors;
- Provide information, including overall goals and responsibilities, on 
research projects ongoing or completed during the last three years.
- List selected peer-reviewed publications, with full citations;

o CHECKLIST - This page should be completed and submitted with the 
application. If the F&A rate agreement has been established, indicate the type 
of agreement and the date. All appropriate exclusions must be applied  in the 
calculation of the F&A costs for the initial budget period and all future 
budget years.

o The applicant should provide the name and phone number of the individual to 
contact concerning fiscal and administrative issues if additional information 
is necessary following the initial review. 

The title and number of the program announcement must be typed on line 2 of 
the face page of the application form and the YES box must be marked.

Submit a signed, typewritten original of the application, including the 
Checklist, and five signed photocopies in one package to:

BETHESDA, MD  20892-7710
BETHESDA, MD  20817 (for express/courier service)


Applications will be assigned on the basis of established PHS referral 
guidelines.  Applications will be evaluated for scientific and technical merit 
by an appropriate scientific review group convened in accordance with the 
standard NIH peer review procedures.  As part of the initial merit review, all 
applications will receive a written critique and undergo a process in which 
only those applications deemed to have the highest scientific merit, generally 
the top half of applications under review, will be discussed, assigned a 
priority score, and receive a second level review by the appropriate National 
Advisory Council.

Review Criteria

The goals of NIH-supported research are to advance our understanding of 
biological systems, improve the control of disease, and enhance health.  In 
the written comments reviewers will be asked to discuss the following aspects 
of the application in order to judge the likelihood that the proposed research 
will have a substantial impact on the pursuit of these goals.  Each of these 
criteria will be addressed and considered in assigning the overall score, 
weighting them as appropriate for each application.  Note that the application 
does not need to be strong in all categories to be judged likely to have major 
scientific impact and thus deserve a high priority score.  For example, an 
investigator may propose to carry out important work that by its nature is not 
innovative but is essential to move a field forward.

(1) Significance:  Does this study address an important problem?  If the aims 
of the application are achieved, how will scientific knowledge be advanced?  
What will be the effect of these studies on the concepts or methods that drive 
this field?

(2) Approach:  Are the conceptual framework, design, methods, and analyses 
adequately developed, well-integrated, and appropriate to the aims of the 
project?  Does the applicant acknowledge potential problem areas and consider 
alternative tactics?

(3) Innovation:  Does the project employ novel concepts, approaches or method? 
Are the aims original and innovative?  Does the project challenge existing 
paradigms or develop new methodologies or technologies?

(4) Investigator:  Is the investigator appropriately trained and well suited 
to carry out this work?  Is the work proposed appropriate to the experience 
level of the principal investigator and other researchers (if any)?

(5) Environment:  Does the scientific environment in which the work will be 
done contribute to the probability of success?  Do the proposed experiments 
take advantage of unique features of the scientific environment or employ 
useful collaborative arrangements?  Is there evidence of institutional 

In addition to the above criteria, in accordance with NIH policy, all 
applications will also be reviewed with respect to the following:

o  The adequacy of plans to include both genders, minorities and their 
subgroups, and children as appropriate for the scientific goals of the 
research.  Plans for the recruitment and retention of subjects will also be 

o  The reasonableness of the proposed budget and duration in relation to the 
proposed research

o  The adequacy of the proposed protection for humans, animals or the 
environment, to the extent they may be adversely affected by the project  
proposed in the application.

Additional scientific/technical merit criteria specific to the objectives of 
the PA and the mechanism used must be included if they are to be used in the 


Applications will compete for available funds with all other recommended 
applications. The following will be considered in making funding decisions:  
Quality of the proposed project as determined by peer review, availability of 
funds, and program priority.


Inquiries are encouraged.  The opportunity to clarify any issues or questions 
from potential applicants is welcome.

Direct inquiries regarding GENERAL ISSUES to:

Dr. Nell Armstrong
Division of Extramural Activities
National Institute of Nursing Research
Building 45, Room Number 3AN12, MSC 6300
Bethesda, MD  20892-6300
Telephone:  (301) 594-5973
FAX:  (301) 480-8260

Direct inquiries regarding specific PROGRAMMATIC ISSUES to the staff of the 
appropriate Institute/Center:

Dr. Nell Armstrong
Division of Extramural Activities
National Institute of Nursing Research
Building 45, Room 3AN12, MSC 6300
Bethesda, MD  20892-6300
Telephone:  (301) 594-5973
FAX:  (301) 480-8260

Dr. Carol H. Letendre, Ph.D.
Division of Blood Diseases and Resources
National Heart, Lung, and Blood Institute
6701 Rockledge Drive, Room 10162, MSC 7950
Bethesda, MD  20892-7950
Telephone:  301-435-0080
FAX: 301-480-0867

Marcia G. Ory, Ph.D., M.P.H.
Behavioral and Social Research Program
National Institute on Aging
7201 Wisconsin Avenue, Room 533 MSC 9025
Bethesda, MD 20892-9205
Telephone: 301-402-4156
FAX:  301-402-0051
Email: Marcia_Ory@NIH.GOV

Susana Serrate-Sztein, M.D.
Rheumatic Diseases Branch
National Institute of Arthritis and Musculoskeletal and Skin Diseases
45 Center Drive, Natcher Bldg. Rm. 5A25
Bethesda MD 20892-6500
Telephone: (3101) 594-5032
FAX (301) 480-4543

Lynne M. Haverkos, M.D., MPH
Child Development and Behavior Branch
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 4B05B, MSC 7510
Bethesda, MD 20892-7510
Telephone: (301) 435-6881
FAX: (301) 480-7773

Paul L Kimmel, MD
Division of Kidney Urologic and Hematologic Diseases
National Institute of Diabetes and Digestive and Kidney Diseases
6707 Democracy Boulevard, Room 607, MSC 5458
Bethesda, MD  20892-5458
Telephone: 301-594-7717
FAX: 301-480-3510

Peter Muehrer, Ph.D.
Division of Mental Disorders, Behavioral Research, and AIDS
National Institute of Mental Health
6001 Executive Boulevard, Room 6189, MSC 9615
Bethesda, MD  20892-9615
Telephone: 301-443-4708
FAX: 301-480-4415

Barbara Radziszewska, PhD, MPH
Clinical Research Project Manager
National Institute of Neurological Disorders and Stroke
6001 Executive Boulevard, Room 2215, MSC 9520
Bethesda, MD 20892-9520
Rockville, MD 20852 (for courier/express service)  
Telephone:  (301) 496-2076
FAX:  (301) 480-1080

Direct inquiries regarding FISCAL MATTERS to:

Mr. Robert Tarwater
Office of Grants and Contracts Management
National Institute of Nursing Research
Building 45, Room Number 3AN12, MSC 6300
Bethesda, MD  20892-6300
Telephone:  (301) 594-2807
FAX:  (301) 480-8260

Ms. Suzanne White
Division of Extramural Affairs
National Heart, Lung, and Blood Institute
6701 Rockledge Drive, Room 7174, MSC 7926
Bethesda, MD  20892-7926
Telephone: 301-435-0166
Fax: 301-480-3310

Mr. David Reiter
Grants Management Office
National Institute on Aging
Gateway Building, Room 2N212
Bethesda, MD 20892
Telephone: 30l-496-1472
FAX:  301-402-3672
Email: David_Reiter@NIH.GOV

Ms. Melinda Nelson
Grants Management Officer
National Institute of Arthritis and Musculoskeletal and Skin Diseases
45 Center Drive, Natcher Bldg. Rm. 5A49F
Bethesda, MD  20892-6500
Telephone: (3101) 594-3505
FAX (301) 480-4543

E. Douglas Shawver
Grants Management Branch
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 8A17, MSC 7510
Bethesda, MD 20892-7510
Telephone: (301) 435-6999
FAX: (301) 402-0915

Ms. Cheryl Chick
Grants Management Specialist
National Institute of Diabetes and Digestive and Kidney Diseases
6707 Democracy Boulevard, Room 606
Bethesda, MD  20892-5456
Telephone: 301-594-8825
FAX: 301-480-3504

Ms. Diana S. Trunnell
Grants Management Branch
National Institute of Mental Health
6001 Executive Boulevard, Room 6115, MSC 9605
Bethesda, MD 20892-9605
Telephone: (301) 443-2805
FAX:  (301) 443-6885

Gladys Melendez-Bohler, M.S. 
Grants Management Branch
National Institute of Neurological Disorders and Stroke
6001 Executive Boulevard, Suite 3262 
Rockville, MD  20892 
Telephone: 301-496-3929
FAX: 301-402-0219 


This program is described in the Catalog of Federal Domestic Assistance Nos. 
93.361 (NINR); 93.839 (NHLBI); 93.866 (NIA); 93.846 (NIAMS); 93.865 (NICHD); 
93.849 (NIDDK); 93.242 (NIMH); and 93.853 (NINDS).  Awards are made under 
authorization of sections 301 and 405 of the Public Health Service Act as 
amended (42 USC 241 and 284) and administered under NIH grants policies and 
Federal Regulations 42 CFR 52 and 45 CFR Parts 74 and 92.  This program is not 
subject to the intergovernmental review requirements of Executive Order 12372 
or Health Systems Agency review.

The PHS strongly encourages all grant and contract recipients to provide a 
smoke-free workplace and promote the non-use of all tobacco products.  In 
addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking 
in certain facilities (or in some cases, and portion of a facility) in which 
regular or routine education, library, day care, health care or early 
childhood development services are provided to children.  This is consistent 
with the PHS mission to protect and advance the physical and mental health of 
the American people.

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