A number of systematic reviews have identified evidence for the effectiveness of self-management interventions to improve of the management of chronic conditions.
What works to support self-management?
- a whole-systems approach to implementation which intervenes at the level of the patient, the health service and the organisation
- provision of education about the chronic condition and how to self-manage, recognising the pre-existing knowledge and beliefs
- involving people in decision-making
- emphasising problem-solving
- developing care plans as a partnership between service users and professionals
- setting goals and following up on the extent to which these are achieved over time
- promoting healthy lifestyles
- motivating people to self-manage using targeted approaches and structured information and support
- helping people to monitor their symptoms and know when to take appropriate action
- helping people to manage the social, emotional and physical impacts of their conditions
- proactive follow up
- social support as appropriate
- provision of opportunities to share and learn from other service users.
A wide range of initiatives exist that can support self-management. These can be categorised along a continuum of interventions:
- focus on self-efficacy, for example self-monitoring, care plans, action plans
- behaviour change, for example coaching, motivational interviewing, group programs
- focus on technical skills, for example online courses, self-monitoring devices
- information provision, for example pamphlets, websites.
Evidence shows approaches that focus on behaviour change and supporting self-efficacy can be significantly more effective than others. Information provision alone is unlikely to be sufficient to motivate sustainable behaviour change and improve clinical outcomes.
There is a societal need to address public understanding of chronic conditions and their impact. This lack of a public story for many conditions has been shown to impact on patients’ help-seeking behaviour, and on public perceptions of need.
Systematic reviews: evidence for effectiveness of self-management
- Taylor SJC, Pinnock H, Epiphaniou E, Pearce G, Parke HL, Schwappach A, et al. 2014. A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions (external site). Health Service Delivery Research 2014;2(53).
- De Silva D, 2011. Evidence: Helping people help themselves - A review of the evidence (external site). The Health Foundation - Inspiring Improvement, UK.
- Johnston l, Lardner C and Jepson R, 2008. Overview of Evidence Relating to Shifting the Balance of Care: A Contribution to the Knowledge Base (external site).
- Zwar N, Harris M, Griffiths R, Roland M, Dennis S, Powell Davies G, Hasan I, 2006. A systematic review of chronic condition management (external site) Research Centre for Primary Care and Equity, School of Public Health and Community Medicine UNSW.
- Warsi A, Wang PS, LaValley MP, Avorn J, Solomon DH, 2004. Self-management education programs in chronic condition: A systematic review and methodological critique of the literature (external site); Arch Intern Med. 2004 Vol 164, AUG 9/23.
- Gordon C, Galloway T, 2008. Review of findings on chronic condition self-management program (CDSMP) outcomes: physical, emotional & health related quality of life, healthcare utilization and costs (external site). National Council on Ageing.
- Wagner E, Austin B, Davis C, Hindmarsh M, Schaefer J and Bonomi A, 2001. Improving chronic illness care: Translating evidence into action (external site). Health Affairs, 2001 20(64-78).
- Harris MF and Zwar NA, 2007. Care of patients with chronic condition: the challenge for general practice (external site), MJA 2007; 187 (2):104-107.
- Michie S, van Stralen MM and West R, September, 2011. The Behaviour Change Wheel: A new method for characterising and designing behaviour change interventions (external site)
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Chronic Condition Self-Management