title: Lay and health care professional understandings of self-management: A systematic review and narrative synthesis.
abstract: OBJECTIVE
  Self-management is widely promoted but evidence of effectiveness is limited. Policy encourages health care professionals to support people with long-term conditions to learn self-management skills, yet little is known about the extent to which both parties share a common understanding of self-management. Thus, we compared health care professional and lay understandings of self-management of long-term conditions.
  
  
  METHODS
  Systematic review and narrative synthesis of qualitative studies identified from relevant electronic databases, hand-searching of references lists, citation tracking and recommendations by experts.
  
  
  RESULTS
  In total, 55 studies were included and quality was assessed using a brief quality assessment tool. Three conceptual themes, each with two subthemes were generated: traditional and shifting models of the professional-patient relationship (self-management as a tool to promote compliance; different expectations of responsibility); quality of relationship between health care professional and lay person (self-management as a collaborative partnership; self-management as tailored support) and putting self-management into everyday practice (the lived experience of self-management; self-management as a social practice).
  
  
  CONCLUSIONS
  Self-management was conceptualised by health care professionals as incorporating both a biomedical model of compliance and individual responsibility. Lay people understood self-management in wider terms, reflecting biomedical, psychological and social domains and different expectations of responsibility. In different ways, both deviated from the dominant model of self-management underpinned by the concept of self-efficacy. Different understandings help to explain how self-management is practised and may help to account for limited evidence of effectiveness of self-management interventions.
authors.affiliation: Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London, London, UK.
authors.forename: Euan
authors.initials: E
authors.lastname: Sadler
authors.affiliation: Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.
authors.forename: Charles D A
authors.initials: CD
authors.lastname: Wolfe
authors.affiliation: Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: McKevitt
keywords: Self-management; health care professionals; lay people; long-term conditions; narrative synthesis