title: Aligning everyday life priorities with people's self-management support networks: an exploration of the work and implementation of a needs-led telephone support system.
abstract: BACKGROUND
  Recent initiatives to target the personal, social and clinical needs of people with long-term health conditions have had limited impact within primary care. Evidence of the importance of social networks to support people with long-term conditions points to the need for self-management approaches which align personal circumstances with valued activities. The Patient-Led Assessment for Network Support (PLANS) intervention is a needs-led assessment for patients to prioritise their health and social needs and provide access to local community services and activities. Exploring the work and practices of patients and telephone workers are important for understanding and evaluating the workability and implementation of new interventions.
  
  
  METHODS
  Qualitative methods (interviews, focus group, observations) were used to explore the experience of PLANS from the perspectives of participants and the telephone support workers who delivered it (as part of an RCT) and the reasons why the intervention worked or not. Normalisation Process Theory (NPT) was used as a sensitising tool to evaluate: the relevance of PLANS to patients (coherence); the processes of engagement (cognitive participation); the work done for PLANS to happen (collective action); the perceived benefits and costs of PLANS (reflexive monitoring). 20 patients in the intervention arm of a clinical trial were interviewed and their telephone support calls were recorded and a focus group with 3 telephone support workers was conducted.
  
  
  RESULTS
  Analysis of the interviews, support calls and focus group identified three themes in relation to the delivery and experience of PLANS. These are: formulation of 'health' in the context of everyday life; trajectories and tipping points: disrupting everyday routines; precarious trust in networks. The relevance of these themes are considered using NPT constructs in terms of the work that is entailed in engaging with PLANS, taking action, and who is implicated this process.
  
  
  CONCLUSIONS
  PLANS gives scope to align long-term condition management to everyday life priorities and valued aspects of life. This approach can improve engagement with health-relevant practices by situating them within everyday contexts. This has potential to increase utilisation of local resources with potential cost-saving benefits for the NHS.
  
  
  BACKGROUND
  ISRCTN45433299.
authors.affiliation: NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK. christian.blickem@manchester.ac.uk.
authors.forename: Christian
authors.initials: C
authors.lastname: Blickem
authors.forename: Anne
authors.initials: A
authors.lastname: Kennedy
authors.forename: Praksha
authors.initials: P
authors.lastname: Jariwala
authors.forename: Rebecca
authors.initials: R
authors.lastname: Morris
authors.forename: Robert
authors.initials: R
authors.lastname: Bowen
authors.forename: Ivaylo
authors.initials: I
authors.lastname: Vassilev
authors.forename: Helen
authors.initials: H
authors.lastname: Brooks
authors.forename: Tom
authors.initials: T
authors.lastname: Blakeman
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
mesh_terms: D000368:Aged; D005260:Female; D017144:Focus Groups; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D036301:Qualitative Research; D051436:Renal Insufficiency, Chronic / Q000628:therapy; D012648:Self Care; D012657:Self-Help Groups; D013689:Telephone