Self-management support? Listening to people with complex co-morbidities

2018 ◽  
Vol 16 (3) ◽  
pp. 161-172 ◽  
Author(s):  
Helen Francis ◽  
Jenny Carryer ◽  
Jill Wilkinson
Keyword(s):  
New Zealand ◽  
Early Stage ◽  
The Self ◽  
Self Management ◽  
Management Approach ◽  
Management Support ◽  
Long Term Conditions ◽  
Early Stage Disease ◽  
The Face

Objectives The study aimed to explore how people with complex, established co-morbidities experience long-term condition care in New Zealand. Despite the original conception as appropriate for people with early stage disease, in New Zealand the self-management approach dominates the care provided to people at all stages of diagnosis with long-term conditions, something reinforced through particular funding mechanisms. Methods A multiple case study followed the lives of 16 people with several long-term conditions. Data collection comprised two interviews, four weekly contacts with patients over an 18-month period and an interview with their primary health care clinicians. Results This paper reveals a cohort of tired, distracted patients struggling to manage their lives in the face of multiple conflicting challenges, with insufficient energy for the level of personal agency required to deal with the self-management approach. Discussion Participants described aspects of care received, which does meet their needs but sit outside the self-management approach, that resonate with the ideas behind current approaches to palliative care. The potential of an approach to care built upon these ideas is explored as a more compassionate, effective way of meeting the needs of people with advanced, multiple long-term conditions. Further research is warranted to explore the acceptability of such an approach.

scholarly journals The Flinders Programme of Chronic Condition Self-Management in New Zealand: survey findings

2010 ◽  
Vol 2 (4) ◽  
pp. 288 ◽  
Author(s):  
Margaret Horsburgh ◽  
Janine Bycroft ◽  
Felicity Goodyear-Smith ◽  
Dianne Roy ◽  
Faith Mahony ◽  
...  
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
Chronic Condition ◽  
Complex Interventions ◽  
Time Frame ◽  
Self Management ◽  
Management Support ◽  
Long Term Conditions ◽  
Primary Care Nurses

INTRODUCTION: The Flinders ProgramTM of Chronic Condition Self-Management in New Zealand (NZ) has been given focus as a useful and appropriate approach for self-management support and improvement of long-term condition management. AIM: To determine the use of the Flinders ProgramTM in NZ and identify barriers and enablers to its use. METHOD: A web-based survey was undertaken in June 2009 with 355 eligible participants of the 500 who had completed ‘Flinders’ training in NZ since 2005. RESULTS: 152 (43%) respondents completed the survey over a one-month time frame. Of those who responded, the majority were primary care nurses (80%; 118). Fifty-five percent (82) of survey respondents reported using some or all of the Flinders tools. Of these, 11% (16) reported using all of the tools or processes with 77% (104) of respondents having completed six or fewer client assessments utilising the Flinders tools. This indicates that respondents were relatively inexperienced with use of the Flinders ProgramTM. Barriers to implementation were identified as the time needed for structured appointments (up to one hour), funding, resistance from colleagues, lack of space and insufficient ongoing support. DISCUSSION: Despite the extent of training in the use of the Flinders ProgramTM, there is limited use in clinical practice of the tools and processes associated with the model. Without structured support for quality improvement initiatives and self-management programmes, the ability to implement learned skills and complex interventions is limited. KEYWORDS: Self-management; long-term conditions; chronic conditions; chronic illness; primary care; nurses

Patient expertise: Contested territory in the realm of long-term condition care

2018 ◽  
Vol 15 (3) ◽  
pp. 197-209 ◽  
Author(s):  
Helen Francis ◽  
Jenny Carryer ◽  
Jill Wilkinson
Keyword(s):  
The Self ◽  
Self Management ◽  
Management Approach ◽  
Long Term Conditions ◽  
Expert Patient ◽  
Patient Expertise ◽  
Primary Care Clinicians ◽  
Management Approaches ◽  
Cross Case Analysis

Objectives The aim of this study was to describe the experience of people with multiple long-term conditions with particular reference to the notion of the ‘expert patient’ in the context of self-management. Methods A multiple case study of 16 people with several long-term conditions, included interviews and contacts over an 18-month period and an interview with their primary care clinicians. Analysis included both case-by-case and some cross-case analysis. Results The findings reveal the patient participants had little capacity to exercise the agency necessary be an expert patient as premised. Weariness, shame, expertise, issues of compliance and control and collaboration are contested areas underpinning clinician encounters. Discussion Patient expertise is at the heart of self-management approaches but the findings surfaced several inherent contradictions between the idealised expert patient and their position within a health care system that is entrenched in biomedicine. Conclusion There is a mismatch between how the self-management approach has been operationalised and what the participants who have multiple LTCs reveal as what they want and need. The research concludes that the self-management approach is inappropriate for people with multiple LTCs and that other ways of offering care should be considered.

scholarly journals Using the patient activation measure to examine the self-management support needs of a population of UK workers with long-term health conditions

2021 ◽  
pp. 174239532110434
Author(s):  
Sally Hemming ◽  
Fehmidah Munir
Keyword(s):  
Mental Health ◽  
Patient Activation ◽  
Health Conditions ◽  
Self Management ◽  
Support Needs ◽  
Management Support ◽  
Long Term Conditions ◽  
Mental Health Conditions ◽  
Patient Activation Measure

Objectives To examine differences in patient activation and self-management support needs in a population of UK workers with long-term health conditions. Methods Demographic, health and activation information were taken from the data of participants with long-term conditions, collected via an online cross-sectional survey of workers. The 13-item British patient activation measure measured workers knowledge, skills and confidence towards self-managing. Results Three hundred and seven workers with mental health, musculoskeletal and other conditions completed the patient activation measure. Mental health conditions were most prevalent (36.8%). Workers were higher activated, however workers with mental health conditions were significantly less activated ( p = 0.006). Differences in activation by condition severity and age were revealed. Discussion This study provides insight to the activation of UK workers with long-term conditions. Whilst workers with mental health conditions need more training and education to self-manage, workers are variably activated indicating broader support needs. There is a gap for workplace self-management support. The patient activation measure is used in healthcare to improve people’s self-management and should be considered to be included in the workplace, and could form part of interventions to support workers self-management. More rigorous studies, including the patient activation measure, are needed to identify the best approaches to identifying workers self-management support needs.

scholarly journals The self-management work of food hypersensitivity

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248181
Author(s):  
Monika Dybdahl Jakobsen ◽  
Aud Obstfelder ◽  
Tonje Braaten ◽  
Birgit Abelsen
Keyword(s):  
Conventional Medicine ◽  
Food Hypersensitivity ◽  
The Self ◽  
Food Allergies ◽  
Self Management ◽  
Long Term Conditions ◽  
Individual Interviews ◽  
Irritable Bowel ◽  
Management Work

Background Food hypersensitivity (FH) has received considerable attention in the scientific community in recent years. However, little attention has been given to the efforts people make to manage their FH. We aimed to explore these efforts by using Normalization Process Theory, which is a conceptual framework formerly used to describe the self-management ‘work’ of long-term conditions. Methods We carried out qualitative individual interviews with 16 women with FH. Transcripts from recorded interviews were analyzed using template analysis. Results 16 women participated; some had diagnoses from conventional medicine (celiac disease, lactose intolerance, food allergies, irritable bowel syndrome) and some did not. Participants described carrying out several tasks, some of which were time-consuming, to manage their FH. Women who had clarified once and for all what food(s) caused symptoms, described that they could concentrate on carrying out a restricted diet, which could become routine. Conversely, participants who had not achieved such clarification described carrying out tasks to identify what food(s) caused symptoms, and to implement and evaluate a tentative diet. Participants’ descriptions also revealed a heightened vigilance when they ate food that others had prepared, and some made efforts to conceal their FH. Conclusions Self-management of FH may, like the self-management of other long-term conditions, imply a large workload and burden of treatment. Efforts made to conceal FH may be considered part of this workload, while help in clarifying which food(s) cause symptoms has the potential to reduce the workload.

The Nexus of M-Health and Self-Care

2019 ◽  
pp. 235-259
Author(s):  
Anastasius S. Moumtzoglou
Keyword(s):  
Mobile Health ◽  
Self Care ◽  
Normal Activity ◽  
Models Of Care ◽  
Self Management ◽  
Management Support ◽  
Long Term Conditions ◽  
Concept Of Health ◽  
Health Related

Self-care emerged from the concept of health promotion in the 1970s while from 2000 onwards the term self-management gained popularity, with a greater focus on long-term conditions and the trend towards more holistic models of care. Although self-management and self-care are often used interchangeably, a distinction between the two concepts can be made. Both can be considered in terms of a continuum, with self-care at one end as “normal activity” and self-management an extension of this. Self-management support is the assistance given to patients in order to encourage daily decisions that improve health-related behaviors and clinical outcomes. The chapter envisions these concepts on a continuum with one pole representing mobile health and the other self-care. It concludes that self-management support is the nexus of mobile health and self-care.

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