Putting it into practice: building knowledge, skills and confidence

When health care is designed to support self-management, people with long-term health conditions and their carers play a more active role in managing their own health. This can mean making difficult lifestyle changes. To do this, they need the knowledge, skills and confidence to manage not only their long-term health conditions but also the practical and emotional impact it has on their lives. When this happens, people enjoy life more, have less pain, have improved clinical outcomes and use health care services less.

People with long-term health conditions can be given information to increase their knowledge, but that is often needed together with other forms of support to influence behaviour changes such as taking exercise or practising relaxation techniques. Some conditions require people to have technical skills, for example self-administering medication. Self-efficacy refers to people’s beliefs about their confidence and control over their own actions, which might include trying to find further support. All of these qualities can be important for people at different times. Figure 4 shows the strengths of different types of support in relation to the impact on behaviour change, access to information, technical skills and self-efficacy.

Figure 4: Continuum of strategies for self-management support

Common forms of self-management support

  • Generic structured education courses: these focus on the common experiences of people with any long-term health condition and carers, such as working with health care professionals, coping with pain and managing fatigue. Examples include the Stanford Model, known as the Expert Patient Programme (EPP), and the Patient Skills Programme from the Health Foundation. These can be helpful in encouraging behaviour change.Example: Patient Skills Programmehttp://personcentredcare.health.org.uk/resources/patient-skills-programme
  • Condition-specific structured education courses: these cover specific skills and knowledge needed to manage different conditions. Examples include the DAFNE (Dose Adjusted For Normal Eating) or DESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed) courses for people with diabetes. These can be helpful in encouraging behaviour change and technical skills.Example: International Diabetes Federation Peer Leader Manual http://personcentredcare.health.org.uk/resources/peer-leader-manual
  • One-to-one coaching: provided face-to-face, over the phone or via Skype, this uses reflective listening and motivational interviewing to support individuals with making changes through goal setting. This form of support focuses on improving self-efficacy and behaviour change. Example: Health Coaching by Medical Assistants to Improve Control of Diabetes, Hypertension, and Hyperlipidemia in Low-Income Patients: A Randomized Controlled Trialhttp://personcentredcare.health.org.uk/resources/health-coaching-medical-assistants-improve-control-of-diabetes-hypertension-and
  • Websites: offering specific programmes or forums to help people understand their condition, access information or learn techniques like relaxation. The focus for this form of support is providing information.Example: The Pain Toolkithttp://personcentredcare.health.org.uk/resources/pain-toolkit
  • Recovery colleges: focusing on support for people with mental health conditions, these consist of a range of one-off workshops and longer courses, covering understanding of specific mental health conditions, the recovery model, or general skills such as mindfulness. Like the group courses detailed above, these focus on self-efficacy and behaviour change.Example: Briefing: Recovery colleges http://personcentredcare.health.org.uk/resources/briefing-recovery-colleges

Well-commissioned self-management support programmes for local people provide a range or combination of options that are appropriate to people’s needs and preferences, so people can choose what is best for them. In addition, support must be easily accessible – such as holding courses in the evening in non-health-related community venues.

Many people with a long-term health condition can benefit from different forms of self-management support. Some specific examples are given below.

  • People with low confidence or self-esteem can benefit from the process of coaching or courses.
  • People with mental health conditions can benefit from recovery colleges.
  • Men of working age can benefit from activity based groups and one-to-one education.
  • Carers can benefit from courses where they meet other carers and can manage the impact of their caring duties.
  • Young people can benefit from accessing online support.
  • People from different ethnic backgrounds may benefit from culturally led support.

It is important to be aware that the groups highlighted above are often among those least likely to know about available support. Therefore, comprehensive recruitment strategies would include raising awareness among professionals, voluntary groups, local community, housing or social groups.

Much of this support might be provided outside of a traditional consultation between a health care professional and someone with a long-term health condition. However, all of these types of support are strengthened when backed up by professionals using skills such as motivational interviewing, goal setting and problem solving in consultations.

Facilitators and coaches for self-management can be people with long-term health conditions and health care professionals or other trained individuals. Courses with a strong clinical focus may be co-delivered with a health care professional.

Markers for quality, detailed in national guidelines, include the training and supervision of people providing courses and coaching, evidence-based content, outcome audits and provision of supporting material. These must include outcomes for participants and operational effectiveness.

Without ongoing support, people’s knowledge, skills and confidence to self-manage decline over time. Many programmes therefore include creating peer support groups for people completing courses, and at the very least they can enable people to connect with peers and other forms of ongoing support.

Further reading

Example case studies:

- My Health My Way. Dorset NHS

A comprehensive self-management support service, providing coaching, courses and peer support www.myhealthdorset.org.uk

- Recovery college: From mental health patient to recovery student. Health Foundation.

A short film showing a recovery college in action.www.health.org.uk/recovery-college

Supporting Self-Management. National Voices.

A summary of the evidence of the programmes to support people with long-term health conditions www.nationalvoices.org.uk/sites/www.nationalvoices.org.uk/files/supporting_self-management.pdf

Wellbeing Our Way. National Voices.

A programme looking at community and voluntary groups supporting self-management www.nationalvoices.org.uk/engagementprogramme

Standards for Health Management Programmes and Interventions. QISMET.

The national body for quality assurance of self-management education interventions http://qismet.org.uk/certification/

Previous Next