title: Creating 'good' self-managers?: facilitating and governing an online self care skills training course.
abstract: BACKGROUND
  In chronic disease management, patients are increasingly called upon to undertake a new role as lay tutors within self-management training programmes. The internet constitutes an increasingly significant healthcare setting and a key arena for self-management support and communication. This study evaluates how a new quasi-professional health workforce - volunteer tutors - engage, guide and attempt to manage people with long-term conditions in the ways of 'good' self-management within the context of an online self-management course.
  
  
  METHODS
  A qualitative analysis of postings to the discussion centre of 11 online classes (purposively selected from 27) run as part of the Expert Patients Programme. Facilitators (term for tutors online) and participants posted questions, comments and solutions related to self-management of long-term conditions; these were subjected to a textual and discursive analysis to explore: a) how facilitators, through the internet, engaged participants in issues related to self-management; b) how participants responded to and interacted with facilitators.
  
  
  RESULTS
  Emergent themes included: techniques and mechanisms used to engage people with self-management; the process facilitators followed - 'sharing', 'modelling' and 'confirming'; and the emergence of a policing role regarding online disclosure. Whilst exchanging medical advice was discouraged, facilitators often professed to understand and give advice on psychological aspects of behaviour.
  
  
  CONCLUSIONS
  The study gave an insight into the roles tutors adopt - one being their ability to 'police' subjective management of long-term conditions and another being to attempt to enhance the psychological capabilities of participants.
authors.affiliation: National Primary Care Research and Development Centre, University of Manchester, Manchester, UK. anne.p.kennedy@manchester.ac.uk
authors.forename: Anne
authors.initials: A
authors.lastname: Kennedy
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
authors.forename: Caroline
authors.initials: C
authors.lastname: Sanders
authors.forename: Claire
authors.initials: C
authors.lastname: Gately
authors.forename: Victoria
authors.initials: V
authors.lastname: Lee
mesh_terms: D002908:Chronic Disease; D003194:Computer-Assisted Instruction; D003479:Curriculum; D006801:Humans; D007857:Leadership; D010353:Patient Education as Topic / Q000379:methods*; D036301:Qualitative Research; D012648:Self Care