How much do clinicians support patient self-management? The development of a measure to assess clinician self-management support.
BACKGROUND
Primary care provider (PCP) support of patient self-management may be important mechanism to improving patient health outcomes. In this paper we develop a PCP-reported measure of clinician strategies for supporting patient self-management, and we psychometrically test and validate the measure.


METHODS
We developed survey items based upon effective self-management support strategies identified in a prior mixed methods study. We fielded a survey in the fall of 2014 with 139 Fairview Health Services PCPs, and conducted exploratory factor analysis and Cronbach's Alpha to test for scale reliability. To validate the measure, we examined the Self-Management Support (SMS) scale's relationship to survey items on self-management support, as well as clinicians' patient panel rates of smoking cessation and weight loss.


RESULTS
Nine survey items clustered reliably to create a single factor (Cronbach's Alpha=0.73). SMS scores ranged from 2.1 to 4.9. The SMS was related to each of the validation variables. PCPs who reported spending 60% percent or more of their time counseling, educating, and coaching patients had a mean SMS score of 4.0, while those who reported spending less than 30% of their time doing so had mean SMS scores 15% lower. PCPs' SMS scores exhibited significant but modest associations with their patients' smoking cessation and weight loss (among obese patients) (r=0.21 and r=0.13 respectively).


CONCLUSIONS
This study develops and tests a promising measure of PCPs' strategies to support patient self-management. It highlights variation across PCPs. Future work should examine whether increasing scores of PCPs low on the SMS improves chronic care quality outcomes.
George Washington University, 2030 M Street, Suite 300, Washington, DC 20036, United States. Electronic address: jessgreene@gwu.edu.
Jessica
J
Greene
George Washington University, 2030 M Street, Suite 300, Washington, DC 20036, United States.
Rebecca M
RM
Sacks
University of Oregon, United States.
Judith H
JH
Hibbard
Fairview Medical Group, United States.
Valerie
V
Overton
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D011320:Primary Health Care; D011594:Psychometrics / Q000295:instrumentation / Q000592:standards*; D015203:Reproducibility of Results; D000073278:Self-Management / Q000379:methods*; D016540:Smoking Cessation / Q000379:methods; D012944:Social Support; D011795:Surveys and Questionnaires; D015431:Weight Loss; D000078329:Workforce