title: Implementation of personalized self-management support using the self-management screening questionnaire SeMaS; a study protocol for a cluster randomized trial.
abstract: BACKGROUND
  The number of patients with one or more chronic diseases is rising. In several standards of care there is a focus on enhancing self-management. We applied the concept of personalization on self-management support and developed a self-management screening questionnaire (SeMaS). The main research objective is to assess the effectiveness of the SeMaS questionnaire and subsequent personalized self-management on patients' self-management behaviors.
  
  
  METHODS
  A cluster randomized controlled trial will be set up in 15 general practices in the Netherlands. The practices are all group practices, and member of one care group. The practices will be assigned to the control or intervention arms by stratified randomization. The strata are determined by the participation of the practice nurses in a course for behavioral change, and the nurse's workload. Patients can be included if they are over 18 years of age, have at least one chronic condition and have a checkup appointment with the practice nurse in the inclusion period. The intervention consists of screening patients with the SeMaS questionnaire, producing a graphic profile with the abilities or barriers for self-management. Patients will receive tailored feedback. Practice nurses are trained in using the profile to enhance self-management of the patient and provide personalized self-management support. The use of individual care plans and self-management interventions is stimulated. In the control arm patients will receive care as usual. Patients of both trial arms will be asked to fill in the SeMaS questionnaire and additional questionnaires at inclusion and after 6 months. The primary outcome is the difference in the level of patient activation (PAM-13) between baseline and 6 months. Secondary outcomes include patient measures for lifestyle factors (exercise, diet, smoking), and process measures from medical record data analysis.
  
  
  CONCLUSIONS
  This manuscript presents the protocol for a cluster randomized clinical trial of personalized self-management support using the SeMaS questionnaire in chronically ill patients in primary care. By carrying out this study, scientific evidence is built for the effectiveness of personalized self-management support.
  
  
  BACKGROUND
  The Netherlands National Trial Register: NTR3960.
authors.affiliation: Radboud University Medical Centre, IQ healthcare, P,O, Box 9101, 114 6500 Nijmegen, HB, The Netherlands. nathalie.eikelenboom@radboudumc.nl.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Eikelenboom
authors.forename: Jan
authors.initials: J
authors.lastname: van Lieshout
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: Ivo
authors.initials: I
authors.lastname: Smeele
authors.forename: Annelies E
authors.initials: AE
authors.lastname: Jacobs
mesh_terms: D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D002985:Clinical Protocols; D015897:Comorbidity; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D057285:Precision Medicine / Q000451:nursing*; D011237:Predictive Value of Tests; D011320:Primary Health Care; D012107:Research Design; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012648:Self Care; D011795:Surveys and Questionnaires; D013997:Time Factors