title: Why Health and Social Care Support for People with Long-Term Conditions Should be Oriented Towards Enabling Them to Live Well.
abstract: There are various reasons why efforts to promote "support for self-management" have rarely delivered the kinds of sustainable improvements in healthcare experiences, health and wellbeing that policy leaders internationally have hoped for. This paper explains how the basis of failure is in some respects built into the ideas that underpin many of these efforts. When (the promotion of) support for self-management is narrowly oriented towards educating and motivating patients to adopt the behaviours recommended for disease control, it implicitly reflects and perpetuates limited and somewhat instrumental views of patients. It tends to: restrict the pursuit of respectful and enabling 'partnership working'; run the risk of undermining patients' self-evaluative attitudes (and then of failing to notice that as harmful); limit recognition of the supportive value of clinician-patient relationships; and obscure the practical and ethical tensions that clinicians face in the delivery of support for self-management. We suggest that a focus on enabling people to live (and die) well with their long-term conditions is a promising starting point for a more adequate conception of support for self-management. We then outline the theoretical advantages that a capabilities approach to thinking about living well can bring to the development of an account of support for self-management, explaining, for example, how it can accommodate the range of what matters to people (both generally and more specifically) for living well, help keep the importance of disease control in perspective, recognize social influences on people's values, behaviours and wellbeing, and illuminate more of the rich potential and practical and ethical challenges of supporting self-management in practice.
authors.affiliation: Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK. Vikki.Entwistle@abdn.ac.uk.
authors.forename: Vikki A
authors.identifier: http://orcid.org/0000-0002-0856-4025
authors.initials: VA
authors.lastname: Entwistle
authors.affiliation: School of Education, Communication and Society, King's College London, Waterloo Bridge Wing, Franklin-Wilkins Building, Waterloo Road, London, SE1 9NH, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Cribb
authors.affiliation: School of Education, Communication and Society, King's College London, Waterloo Bridge Wing, Franklin-Wilkins Building, Waterloo Road, London, SE1 9NH, UK.
authors.forename: John
authors.initials: J
authors.lastname: Owens
mesh_terms: D002908:Chronic Disease / Q000523:psychology*; D019468:Disease Management; D006801:Humans; D018802:Patient-Centered Care / Q000379:methods*; D011369:Professional-Patient Relations; D011788:Quality of Life; D012648:Self Care; D012944:Social Support
keywords: Capabilities approach; Chronic conditions; Patient participation; Person centred care; Professional-patient relations; Quality of life