title: Conceptualisation of the 'good' self-manager: A qualitative investigation of stakeholder views on the self-management of long-term health conditions.
abstract: Healthcare policy in developed countries has, in recent years, promoted self-management among people with long-term conditions. Such policies are underpinned by neoliberal philosophy, as seen in the promotion of greater individual responsibility for health through increased support for self-management. Yet still little is known about how self-management is understood by commissioners of healthcare services, healthcare professionals, people with long-term conditions and family care-givers. The evidence presented here is drawn from a two-year study, which investigated how self-management is conceptualised by these stakeholder groups. Conducted in the UK between 2013 and 2015, this study focused on three exemplar long-term conditions, stroke, diabetes and colorectal cancer, to explore the issue. Semi-structured interviews and focus groups were carried out with 174 participants (97 patients, 35 family care-givers, 20 healthcare professionals and 22 commissioners). The data is used to demonstrate how self-management is framed in terms of what it means to be a 'good' self-manager. The 'good' self-manager is an individual who is remoralised; thus taking responsibility for their health; is knowledgeable and uses this to manage risks; and, is 'active' in using information to make informed decisions regarding health and social wellbeing. This paper examines the conceptualisation of the 'good' self-manager. It demonstrates how the remoralised, knowledgeable and active elements are inextricably linked, that is, how action is knowledge applied and how morality underlies all action of the 'good' self-manager. Through unpicking the 'good' self-manager the problems of neoliberalism are also revealed and addressed here.
authors.affiliation: Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom. Electronic address: J.Ellis@soton.ac.uk.
authors.forename: J
authors.initials: J
authors.lastname: Ellis
authors.affiliation: Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom.
authors.forename: E
authors.initials: E
authors.lastname: Boger
authors.affiliation: Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Latter
authors.affiliation: NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Kennedy
authors.affiliation: Faculty of Health, Social Care and Education, Kingston University and St Georges University of London, London, United Kingdom.
authors.forename: F
authors.initials: F
authors.lastname: Jones
authors.affiliation: Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom.
authors.forename: C
authors.initials: C
authors.lastname: Foster
authors.affiliation: Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Demain
mesh_terms: D000293:Adolescent; D000328:Adult; D017028:Caregivers / Q000523:psychology; D015179:Colorectal Neoplasms / Q000523:psychology / Q000628:therapy; D003920:Diabetes Mellitus / Q000523:psychology / Q000628:therapy; D006233:Persons with Disabilities / Q000523:psychology*; D019468:Disease Management; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006291:Health Policy / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D020377:Self Efficacy; D000073278:Self-Management / Q000379:methods / Q000523:psychology*; D020521:Stroke / Q000523:psychology / Q000628:therapy; D006113:United Kingdom
keywords: Long-term conditions; Neoliberalism; Person-centred care; Self-management; United Kingdom