Characteristics of a self-management support programme applicable in primary health care: a qualitative study of users' and health professionals' perceptions

Hilde Strøm Solberg, Aslak Steinsbekk, Marit Solbjør, Randi Granbo, Helge Garåsen, Hilde Strøm Solberg, Aslak Steinsbekk, Marit Solbjør, Randi Granbo, Helge Garåsen

Abstract

Background: Development of more self-management support programmes in primary health care has been one option used to enhance positive outcomes in chronic disease management. At present, research results provide no consensus on what would be the best way to develop support programmes into new settings. The aim of the present study was therefore to explore users' and health professionals' perceptions of what would be the vital elements in a self - management support programme applicable in primary health care, how to account for them, and why.

Methods: Four qualitative, semi-structured focus group interviews were conducted in Central Norway. The informants possessed experience in development, provision, or participation in a self-management support programme. Data was analysed by the Systematic Text Condensation method.

Results: The results showed an overall positive expectation to the potential benefits of development of a self-management support programme in primary health care. Despite somewhat different arguments and perspectives, the users and the health professionals had a joint agreement on core characteristics; a self-management support programme in primary health care should therefore be generic, not disease specific, and delivered in a group- based format. A special focus should be on the everyday- life of the participants. The most challenging aspect was a present lack of competence and experience among health professionals to moderate self-management support programmes.

Conclusions: The development and design of a relevant and applicable self-management support programme in primary health care should balance the interests of the users with the possibilities and constraints within each municipality. It would be vital to benefit from the closeness of the patients' every-day life situations. The user informants' perception of a self-management support programme as a supplement to regular medical treatment represented an expanded understanding of the self-management support concept. An exploring approach should be applied in the development of the health professionals' competence in practice. The effect of a self-management support programme based on the core characteristics found in this study needs to be evaluated.

References

    1. Bycroft JJ, Tracey J. Self-management support: A win-win solution for the 21th century. New Zealand Family Physician (NZFP) 2006;33(4):243–248.
    1. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood) 2001;20(6):64–78. doi: 10.1377/hlthaff.20.6.64.
    1. Coleman MT, Newton KS. Supporting self-management in patients with chronic illness. Am Fam Physician. 2005;72(8):1503–1510.
    1. Grandes G, Sanchez A, Cortada JM, Balague L, Calderon C, Arrazola A, Vergara I, Millan E. Is integration of healthy lifestyle promotion into primary care feasible? discussion and consensus sessions between clinicians and researchers. BMC Health Serv Res. 2008;8:213. doi: 10.1186/1472-6963-8-213.
    1. Qaseem A, Wilt TJ, Weinberger SE, Hanania NA, Criner G, van der Molen T, Marciniuk DD, Denberg T, Schunemann H, Wedzicha W, MacDonald R, Shekelle P. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med. 2011;155(3):179–191. doi: 10.7326/0003-4819-155-3-201108020-00008.
    1. European Association of Cardiovascular Prevention and Rehabilitation (EACPR) European Society of Cardiology Committee for Practice Guidelines (ESC-CPG) European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): the Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) Eur J Prev Cardiol. 2012;19(4):585–667. doi: 10.1177/2047487312450228.
    1. Francis CF, Feyer A-M, Smith BJ. Implementing chronic disese self-management in community settings: lessons from Australian demonstartion projects. Aust Health Rev. 2007;31(4):499–509. doi: 10.1071/AH070499.
    1. Lorig KR, Sobel DS, Stewart AL, Brown BW, Jr, Bandura A, Ritter P, Gonzalez VM, Laurent DD, Holman HR. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med Care. 1999;37(1):5–14. doi: 10.1097/00005650-199901000-00003.
    1. Battersby MW, Kit JA, Pridcaux C, Harvey PW, Coffins JP, Mills PD. Implementing the flinders model of self-management support with aboriginal people who have diabetes: findings from a pilot study. Aust J Prim Health. 2008;14(1):66–74. doi: 10.1071/PY08009.
    1. Dosh SA, Holtrop JS, Torres T, Arnold AK, Baumann J, White LL. Changing organizational constructs into functional tools: an assessment of the 5 A’s in primary care practices. Ann Fam Med. 2005;3(Suppl 2):S50–S52. doi: 10.1370/afm.357.
    1. Lawn S, Schoo A. Supporting self-management of chronic health conditions: common approaches. Patient Educ Couns. 2010;80(2):205–211. doi: 10.1016/j.pec.2009.10.006.
    1. Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. nn Behav Med. 2003;26(1):1–7. doi: 10.1207/S15324796ABM2601_01.
    1. Lake AJ, Staiger PK. Seeking the views of health professionals on translating chronic disease self-management models into practice. Patient Educ Couns. 2010;79(1):62–68. doi: 10.1016/j.pec.2009.07.036.
    1. Kennedy A, Rogers A, Gately C. From patients to providers: prospects for self-care skills trainers in the National Health Service. Health Soc Care Community. 2005;13(5):431–440. doi: 10.1111/j.1365-2524.2005.00568.x.
    1. Kawi J. Self-management support in chronic illness care: a concept analysis. Res Theory Nurs Pract. 2012;26(2):108–125. doi: 10.1891/1541-6577.26.2.108.
    1. Harris MF, Williams AM, Dennis SM, Zwar NA, Powell Davies G. Chronic disease self-management: implementation with and within Austarlian general practice. Med J Aust. 2008;189(10):17–20.
    1. Grol RP, Bosch MC, Hulscher ME, Eccles MP, Wensing M. Planning and studying improvement in patient care: the use of theoretical perspectives. Milbank Q. 2007;85(1):93–138. doi: 10.1111/j.1468-0009.2007.00478.x.
    1. Packer TL, Boldy D, Ghahari S, Melling L, Parsons R, Osborne RH. Self-management programs conducted within a practice setting: who participates, who benefits and what can be learned? Patient Educ Couns. 2012;87(1):93–100. doi: 10.1016/j.pec.2011.09.007.
    1. Scott SD, Grimshaw J, Klassen TP, Nettel-Aguirre A, Johnson DW. Understanding implementation processes of clinical pathways and clinical practice guidelines in pediatric contexts: a study protocol. Implementation Sci. 2011;6:133. doi: 10.1186/1748-5908-6-133.
    1. Glasgow NJ, Jeon Y-H, Kraus SG, Pearce-Brown CL. Chronic disease self-management support: the way forward for Australia. Med J Aust. 2008;189(10):14–16.
    1. Jordan JE, Briggs AM, Brand CA, Osborne RH. Enhancing patient engagement in chronic disease self-management support initiatives in Australia: the need for an integrated approach. Med J Aust. 2008;189(10 Suppl):S9–S13.
    1. Peytremann-Bridevaux I, Lauvergeon S, Mettler D, Burnand B. Diabetes care: opinions, needs and proposed solutions of Swiss patients and healthcare professionals: a qualitative study. Diabetes Res Clin Pract. 2012;97(2):242–250. doi: 10.1016/j.diabres.2012.02.021.
    1. Vissenberg C, Nierkens V, Uitewaal PJ, Geraci D, Middelkoop BJ, Nijpels G, Stronks K. The DISC (Diabetes in Social Context) Study-evaluation of a culturally sensitive social network intervention for diabetic patients in lower socioeconomic groups: a study protocol. BMC Public Health. 2012;12:199. doi: 10.1186/1471-2458-12-199.
    1. Hills M, Mullett J, Carroll S. Community-based participatory action research: transforming multidisciplinary practice in primary health care. Rev Panam Salud Publica. 2007;21(2–3):125–135. doi: 10.1590/S1020-49892007000200007.
    1. Higgins R, Murphy B, Worcester M, Daffey A. Supporting chronic disease self-management: translating policies and principles into clinical practice. Aust J Prim Health. 2012;18(1):80–87. doi: 10.1071/PY11006.
    1. Gardner KL, Dowden M, Togni S, Bailie R. Understanding uptake of continuous quality improvement in Indigenous primary health care: lessons from a multi-site case study of the audit and best practice for chronic disease project. Implementation Science : IS. 2010;5:21. doi: 10.1186/1748-5908-5-21.
    1. Norwegian Ministry of Health and Care services: White paper nr. 47 (2008 – 2009). the coordination reform, proper treatment – at the right place and right time. 2008, .
    1. Norway and health. An introduction. In Edited by Health NDo. 2009. .
    1. Statistics, population,1.January 2014.
    1. LAW-1999-07-02-61 Hospitals Act (in Norwegian only).
    1. Steihaug S, Hatling T. SINTEF Report A6 /2006. Oslo: Sintef Health; 2006. Evaluation of the Norwegian National Advisory Unit on Learning and Mastery.
    1. Kvale S, Brinkmann S. Inter-View: Learning the Craft of Qualitative Research Interviewing. Los Angeles, CA: Sage Publications; 2009.
    1. Morgan DL. Focus groups as qualitative research, vol. 16. Newsbury Park, CA: Sage Publication; 1997.
    1. Malterud K. Systematic text condensation: a strategy for qualitative analysis. Scand J Public Health. 2012;40(8):795–805. doi: 10.1177/1403494812465030.
    1. Dixon A, Hibbard J, Tusler M. How do people with different levels of activation self-manage their chronic conditions? The Patient. 2009;2(4):257–268. doi: 10.2165/11313790-000000000-00000.
    1. Crespo R, Shrewsberry M. Factors associated with integrating self-management support into primary care. Diabetes Educ. 2007;33(Suppl 6):126S–131S. doi: 10.1177/0145721707304138.
    1. Renders CM, Valk GD, Griffin S, Wagner EH, Eijk JT, Assendelft WJ. Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings. Cochrane Database Syst Rev. 2001;1
    1. Brady TJ, Murphy L, O’Colmain BJ, Beauchesne D, Daniels B, Greenberg M, House M, Chervin D. A meta-analysis of health status, health behaviors, and healthcare utilization outcomes of the chronic disease self-management program. Prev Chronic Dis. 2013;10:120112. doi: 10.5888/pcd10.120112.
    1. McColl MA, Shortt S, Godwin M, Smith K, Rowe K, O’Brien P, Donnelly C. Models for integrating rehabilitation and primary care: a scoping study. Arch Phys Med Rehabil. 2009;90(9):1523–1531. doi: 10.1016/j.apmr.2009.03.017.
    1. Nossum R, Rise MB, Steinsbekk A. Patient education - which parts of the content predict impact on coping skills? Scand J Public Health. 2013;41(4):429–435. doi: 10.1177/1403494813480279.
    1. Nordgren L, Asp M, Fagerberg I. Support as experienced by men living with heart failure in middle age: a phenomenological study. Int J Nurs Stud. 2008;45(9):1344–1354. doi: 10.1016/j.ijnurstu.2007.10.005.
    1. Perrin KM, Burke SG, O’Connor D, Walby G, Shippey C, Pitt S, McDermott RJ, Forthofer MS. Factors contributing to intervention fidelity in a multi-site chronic disease self-management program. Implementation Science: IS. 2006;1:26. doi: 10.1186/1748-5908-1-26.
    1. Zwarenstein M, Treweek S. What kind of randomized trials do we need? CMAJ. 2009;180(10):998–1000. doi: 10.1503/cmaj.082007.
    1. Lemieux V, Levesque JF, Ehrmann-Feldman D. Are primary healthcare organizational attributes associated with patient self-efficacy for managing chronic disease? Healthcare Policy. 2011;6(4):e89–e105.
    1. Liaw ST, Lau P, Pyett P, Furler J, Burchill M, Rowley K, Kelaher M. Successful chronic disease care for Aboriginal Australians requires cultural competence. Aust N Z J Public Health. 2011;35(3):238–248. doi: 10.1111/j.1753-6405.2011.00701.x.
    1. Skau G. Gode fagfolk vokser - personlig kompetanse som utfordring (Good professionals grow -personal competence as a challenge) Oslo: Cappelen Damm Academic; 2011.
    1. Hills S. Performance. Twelve steps to perfect competence. Health Serv J. 2009;25(Suppl):6–7.
    1. Crabtree BF, Nutting PA, Miller WL, McDaniel RR, Stange KC, Jaen CR, Stewart E. Primary care practice transformation is hard work: insights from a 15-year developmental program of research. Med Care. 2011;49(Suppl):S28–S35. doi: 10.1097/MLR.0b013e3181cad65c.

Source: PubMed

3
Subscribe