Self management works
November 2010
Supporting self management
Supporting self management involves providing information and
encouragement to help people understand their condition, monitor
symptoms and take appropriate action.
This may include:
─ involving people in decision making
─ promoting healthily lifestyles
─ providing education about conditions and self care
─ motivating people to look after themselves
─ setting goals and checking whether these are achieved over time
─ proactively following up
─ providing opportunities to share and learn from other people
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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.
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Self management works
Research shows that supporting self
management can improve:
─ self confidence / self efficacy
─ self care behaviours
─ quality of life
─ clinical outcomes
─ patterns of healthcare use
A review of almost 600 studies found that
when people are supported to look after
themselves, they feel better, enjoy life more
and have less need to visit GPs or hospitals.
There is a lot of evidence from systematic
reviews and randomised trials and much
of the research is good quality.
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Evidence base
Evidence for supporting self management grows
every year.
Research is up to date. Most studies have been
published in the past 15 years.
Studies from the UK, North America, Europe,
Australasia and Asia are available. The findings are
similarly positive across all countries.
Research includes systematic reviews, randomised
trials and observational and comparative studies.
Studies range from including tens of people to
several thousand people.
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Examples of improvement
─
A Cochrane review of 36 trials found that self monitoring and agenda setting
reduced hospitalisations, A&E visits, unscheduled visits to the doctor and
days off work or school for people with asthma (Gibson et al 2004).
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A US trial found that personalised goal setting for older women with heart
conditions reduced days in hospital and overall healthcare costs (Wheeler et al
2003).
─
A trial found that telephone support may improve self care behaviour,
glycaemic control, and symptoms among vulnerable people with diabetes
(Piette et al 2000).
─
US researchers found that motivational interviewing helped improve self
efficacy, patient activation, lifestyle change and perceived health status (Linden
et al 2010).
─
A large meta analysis found that individual education and group sessions
improved symptoms for people with high blood pressure (Boulware et al 2001).
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Active support works best
There is a continuum.
─ There are many ways to support self
management.
─ Some approaches are passive and focus
on improving technical knowledge.
─ Other ways are more active and focus on
changing confidence and behaviours.
Research shows that more active support works best to improve
outcomes.
Knowledge in this area is developing so the best ways to support
behaviour change are uncertain. Co-creating Health is testing approaches.
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Increase self efficacy
Evidence shows that methods that improve people’s self efficacy are most
effective.
Approaches that focus on whether people are ready to change work
well.
Effective ways to encourage people to self manage include:
─ psychological behaviour change programmes
─ proactive group education
─ motivational interviewing
─ telephone coaching
─ regular follow up
─ self monitoring
─ action plans and goal setting
Information alone is not enough.
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Key messages
Supporting self management works.
There is a lot of good evidence available: more
than 600 studies.
Active approaches that get people motivated
and help change behaviour are more effective
than information alone.
Active approaches can help people feel more
confident and empowered, improve clinical
outcomes and change patterns of service use.
It is important to support clinicians and
understand the skills they need to help people
feel motivated to change.
We are continuing to learn which are the best
approaches
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