Self management works November 2010

Supporting self management 2 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

3 “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.

4 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. Self management works

5 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. Evidence base

6 ─ 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). ─ 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). Examples of improvement

7 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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9 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. Increase self efficacy

10 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