Self-management approaches for people with chronic conditions: a review
Introduction
Longer life expectancy and increasing numbers of people living with chronic conditions accompany the greying of the demographic profile. The burden of meeting the needs of this growing number of people will fall upon already over-stretched health care services that are struggling to cope with the demands of acute care let alone the needs of those with long-term health conditions.
A parallel development is the shift away from paternalistic models of health care that sited the patient in the role of passive recipient. The more active involvement demanded by many patients is in keeping with the realities of chronic disease whereby responsibility for day-to-day disease management gradually shifts from health care professionals to the individual. Indeed, the UK initiatives such as NHS Direct and the Expert Patients Task Force are based on the notion of patients as ‘experts’ able to access information relevant to their health care needs and to carry out the self-management tasks needed for their condition at a given point of time.
There is no ‘gold standard’ definition of self-management. Alderson et al. [1] refer to self-management as
Clearly, this definition excludes any individualised approaches to self-management. Nakagawa-Kogan et al. [2] describe self-management as a treatment that combines biological, psychological and social intervention techniques, with a goal of maximal functioning of regulatory processes. A review by Clark et al. [3] suggests that, in general, authors interpret ‘self-care’ as a preventative strategy (i.e. tasks performed by healthy people at home). In contrast, they maintain that ‘self-management’ is interpreted as theinter-disciplinary group education, based on the principles of adult learning, individualised treatment and case management theory.
day-to-day tasks an individual must undertake to control or reduce the impact of disease on physical health status. At-home management tasks and strategies are undertaken with the collaboration and guidance of the individual’s physician and other health care providers ([3], p. 5).
Clark et al. [3] suggest that individuals also have to cope with the psychosocial problems generated by chronic disease and must manage daily living according to their financial and social conditions. They further suggest that successful self-management of chronic conditions requires sufficient knowledge of the condition and its treatment, performance of condition management activities and application of the necessary skills to maintain adequate psychosocial functioning. Thus, for the purpose of this review, self-management is defined as follows.
Hence, it is not surprising that the value of self-management interventions that train patients to utilise relevant skills is the subject of increased attention and was mentioned in recent White papers in the UK [5]. Self-management may be one means of bridging the gap between patients’ needs and the capacity of health and social care services to meet those needs.Self-management refers to the individual’s ability to manage the symptoms, treatment, physical and psychosocial consequences and life style changes inherent in living with a chronic condition. Efficacious self-management encompasses ability to monitor one’s condition and to effect the cognitive, behavioural and emotional responses necessary to maintain a satisfactory quality of life. Thus, a dynamic and continuous process of self-regulation is established [4].
The purpose of this study was to produce an overview of published literature on self-management in chronic conditions. Objectives were:
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to identify approaches to self-management;
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to consider the effectiveness of different approaches to self-management.
Section snippets
Methods
Since there is no ‘gold standard’ definition of self-management, searches were conducted to identify papers that purported to be on self-management. Searches on BIOMED, BIDS (Social Sciences and Science database), CINAHL, MEDLINE, PSYCLIT and Cochrane Library (York, UK) using the key words: ‘self-management and chronic’ yielded a total of 1129 papers (a prior search on ‘self-management and chronic disease’ produced few references).
Inclusion criteria for the overview were (1) report of a
Results
Results are presented under the following headings: chronic conditions, country, self-management approach (e.g. format, content, tutors), outcomes and effectiveness.
Discussion
The largest proportion of the studies included in this overview was published in the 1990s confirming that self-management is a growth area for a number of chronic conditions in many countries around the world. Indeed, in the UK the establishment of the Expert Patients Task Force to investigate the feasibility of self-management interventions is testament to the burgeoning interest at governmental level.
The number of non-RCT studies reporting within-group change over time or process evaluations
Acknowledgements
The authors extend their thanks to the following for their help during the identification and collection of papers for this overview: Michelle Barlow, Kuldeep Kalsi, Suzanne Wright, Dr. L. Wollner, Melanie Peffer from Department of Health, the Long Term Medical Conditions Alliance, National Asthma Campaign, Manic Depression Fellowship and the British Diabetic Association. The paper is based on an overview commissioned by the Department of Health, UK, under remit of the Expert Patients Task
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