"Was that a success or not a success?": a qualitative study of health professionals' perspectives on support for people with long-term conditions.
BACKGROUND
Support for self-management (SSM) is a prominent strand of health policy internationally, particularly for primary care. It is often discussed and evaluated in terms of patients' knowledge, skills and confidence, health-related behaviours, disease control or risk reduction, and service use and costs. However, these goals are limited, both as guides to professional practice and as indicators of its quality. In order to better understand what it means to support self-management well, we examined health professionals' views of success in their work with people with long-term conditions. This study formed part of a broader project to develop a conceptual account of SSM that can reflect and promote good practice.


METHODS
Semi-structured individual interviews (n = 26) and subsequent group discussions (n = 5 groups, 30 participants) with diverse health professionals working with people with diabetes and/or Parkinson's disease in NHS services in London, northern England or Scotland. The interviews explored examples of more and less successful work, ways of defining success, and ideas about what facilitates success in practice. Subsequent group discussions considered the practical implications of different accounts of SSM. Interviews and group discussions were audio-recorded, transcribed and analysed thematically.


RESULTS
Participants identified a wide range of interlinked aspects or elements of success relating to: health, wellbeing and quality of life; how well people (can) manage; and professional-patient relationships. They also mentioned a number of considerations that have important implications for assessing the quality of their own performance. These considerations in part reflect variations in what matters and what is realistically achievable for particular people, in particular situations and at particular times, as well as the complexity of questions of attribution.


CONCLUSIONS
A nuanced assessment of the quality of support for self-management requires attention to the responsiveness of professional practice to a wide, complex range of personal and situational states, as well as actions and interactions over time. A narrow focus on particular indicators can lead to insensitive or even perverse judgements and perhaps counterproductive effects. More open, critical discussions about both success and the assessment of quality are needed to facilitate good professional practice and service improvement initiatives.
Centre for Public Policy Research, King's College London, Waterloo Bridge Wing, Franklin-Wilkins Building, Waterloo Rd, London, UK, SE1 9NH.
John
J
Owens
Health Services Research Unit, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, UK, AB25 2ZD. vikki.entwistle@abdn.ac.uk.
Vikki A
VA
Entwistle
Centre for Public Policy Research, King's College London, Waterloo Bridge Wing, Franklin-Wilkins Building, Waterloo Rd, London, UK, SE1 9NH.
Alan
A
Cribb
Health Services Research Unit, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, UK, AB25 2ZD.
Zoë C
ZC
Skea
Centre for Public Policy Research, King's College London, Waterloo Bridge Wing, Franklin-Wilkins Building, Waterloo Rd, London, UK, SE1 9NH.
Simon
S
Christmas
Health Services Research Unit, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, UK, AB25 2ZD.
Heather
H
Morgan
Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, UK, YO10 5DD.
Ian S
IS
Watt
D003695:Delivery of Health Care / Q000592:standards*; D004739:England; D006291:Health Policy; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011320:Primary Health Care / Q000592:standards*; D011369:Professional-Patient Relations; D036301:Qualitative Research; D011788:Quality of Life; D012606:Scotland; D012648:Self Care / Q000592:standards*
Chronic conditions; Diabetes; Outcome assessment; Parkinson’s disease; Quality of healthcare; Self-management