The theory and evidence behind self management

Natalie GrazinAssistant DirectorThe Health Foundation

Care pathways: providingspecific interventions

Care planning: A system of regular scheduled appointments, providing proactive structured support

NB : People may also be accessing a wide variety of other support e.g. from within their communities

Life with a long term condition: the person’s perspectiveInteractions with the service: planned or unplanned Problem solving:

Time limited consultation/s providing motivational support

Why support self-management?

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“Self management support can be viewed in two ways: as a portfolio of techniques and tools that help patients choose healthy behaviours; and a fundamental transformation of the patient-caregiver relationship into a collaborative partnership.”

Bodenheimer T, MacGregor K, Shafiri C (2005). Helping Patients Manage Their Chronic Conditions. California: California Healthcare Foundation.

What is self-management support?

The problems:

• Lack of care coordination • Lack of active follow-up• Patients inadequately trained to

manage their illnesses

The Chronic Care Model

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‘Overcoming these deficiencies will require nothing less than a transformation of health care, from a system that is essentially reactive - responding mainly when a person is sick - to one that is proactive and focused on keeping a person as healthy as possible.’

The Chronic Care Model

Developed by the MacColl InstituteACP-ASIM Journals and Books 5

‘Overcoming these deficiencies will require nothing less than a transformation of health care, from a system that is essentially reactive - responding mainly when a person is sick - to one that is proactive and focused on keeping a person as healthy as possible.’

Supporting people on

their journey of activation

Supporting people on

their journey of activation

Understanding have role;

confident and capable in role

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Evidence for supporting self management grows every year.

It shows that supporting self-management can improve:

The evidence

• self confidence / self efficacy

• self management behaviours

• quality of life

• clinical outcomes

• patterns of healthcare use

• Research is up to date

• Internationally, studies are consistently positive

• Research has used a range of methodologies.

• Studies are from small to large scale.

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Active support works best

Research shows that more active support focused on self-efficacy (confidence) and behaviour works best to improve outcomes.

Information and knowledge alone are not enough.

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Active support works best

Source: Prof Judy Hibbard, University of Oregon

Approaches that focus on whether people are ready to change work well.

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• Self monitoring and agenda setting reduce hospitalisations, A&E visits, unscheduled visits to the doctor and days off work or school for people with asthma (Gibson et al 2004).

• Goal setting for older women with heart conditions reduces days in hospital and overall healthcare costs (Wheeler et al 2003).

• Telephone support may improve self care behaviour, glycaemic control, and symptoms among vulnerable people with diabetes (Piette et al 2000).

• Motivational interviewing improve self efficacy, patient activation, lifestyle change and perceived health status (Linden et al 2010).

• Individual education and group sessions improve symptoms for people with high blood pressure (Boulware et al 2001).

Examples of improvement

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More information

Visit our self management support resource centre on the Health Foundation’s website:

www.health.org.uk/sms