Tailoring Self-Management in Chronic Care

Abstract

Self-management is nowadays seen as an important element in chronic care and therefore, self-management is increasingly embedded in chronic care guidelines; however, implementation in clinical practice is a slow and difficult process. Evidence, from research on self-management interventions, shows that self-management support can have beneficial effects; however, it is not effective in everyone. These interventions are mostly one-size-fits all interventions. The hypothesis underlying this PhD project was that a more tailored approach would lead to more efficacious self-management support. To optimize tailoring of interventions, a thorough understanding of effective intervention ingredients is required, as well as knowledge of tailoring strategies and subgroups of patients in which a given self-management intervention is most effective. Our aim with this thesis was to study patient factors that are of influence on self-management, the perceptions of care providers towards tailoring self-management, how self-management is tailored in clinical practice, what patient factors are involved in tailoring self-management support, and what nurses need to provide tailored self-management support. We conclude that many different perceptions exist regarding the terminology of self-management and related concepts, which leads to substantial variations in the provision of self-management support. Furthermore, patient assessment was found the key driver of tailoring; however there is wide variation in the way and extent this assessment is currently performed. The quality of the assessment determines whether and how self-management support is tailored in clinical practice. Many patient factors play a role in an individual’s capacity and activation for self-management. In decision-making towards self-management support care providers consider motivation as the most important factor. Adequate self-management requires behaviour change in both patients and healthcare providers. Nurses need adequate time, tools and training to learn how to apply effective self-management support, and to actively change their role during consultations from professional driven to patient centred approaches. We found that a structured approach encompassing behaviour change techniques can help patients to adequately change their behaviour and thus increase their self-management. Throughout this thesis we have identified many relevant factors that can influence the success of self-management. Tailoring is complex and requires substantial knowledge of the individual patient factors that can influence self-management capacity. Care providers need to obtain more knowledge of these factors, and more education in self-management support and behaviour change. When care providers receive more training in these aspects, it is to be expected that self-management support will become more integrated in routine care and more tailored to the individual.