Elsevier

Patient Education and Counseling

Volume 48, Issue 2, October–November 2002, Pages 177-187
Patient Education and Counseling

Self-management approaches for people with chronic conditions: a review

https://doi.org/10.1016/S0738-3991(02)00032-0Get rights and content

Abstract

The purpose of this paper is to provide an overview of self-management approaches for people with chronic conditions. The literature reviewed was assessed in terms of the nature of the self-management approach and the effectiveness. Findings are discussed under the headings of: chronic conditions targeted, country where intervention was based, type of approach (e.g. format, content, tutor, setting), outcomes and effectiveness. The last of these focused on reports of randomised controlled studies.

Introduction

Longer life expectancy and increasing numbers of people living with chronic conditions accompany the greying of the demographic profile. The burden of meeting the needs of this growing number of people will fall upon already over-stretched health care services that are struggling to cope with the demands of acute care let alone the needs of those with long-term health conditions.

A parallel development is the shift away from paternalistic models of health care that sited the patient in the role of passive recipient. The more active involvement demanded by many patients is in keeping with the realities of chronic disease whereby responsibility for day-to-day disease management gradually shifts from health care professionals to the individual. Indeed, the UK initiatives such as NHS Direct and the Expert Patients Task Force are based on the notion of patients as ‘experts’ able to access information relevant to their health care needs and to carry out the self-management tasks needed for their condition at a given point of time.

There is no ‘gold standard’ definition of self-management. Alderson et al. [1] refer to self-management as

inter-disciplinary group education, based on the principles of adult learning, individualised treatment and case management theory.

Clearly, this definition excludes any individualised approaches to self-management. Nakagawa-Kogan et al. [2] describe self-management as a treatment that combines biological, psychological and social intervention techniques, with a goal of maximal functioning of regulatory processes. A review by Clark et al. [3] suggests that, in general, authors interpret ‘self-care’ as a preventative strategy (i.e. tasks performed by healthy people at home). In contrast, they maintain that ‘self-management’ is interpreted as the

day-to-day tasks an individual must undertake to control or reduce the impact of disease on physical health status. At-home management tasks and strategies are undertaken with the collaboration and guidance of the individual’s physician and other health care providers ([3], p. 5).

Clark et al. [3] suggest that individuals also have to cope with the psychosocial problems generated by chronic disease and must manage daily living according to their financial and social conditions. They further suggest that successful self-management of chronic conditions requires sufficient knowledge of the condition and its treatment, performance of condition management activities and application of the necessary skills to maintain adequate psychosocial functioning. Thus, for the purpose of this review, self-management is defined as follows.

Self-management refers to the individual’s ability to manage the symptoms, treatment, physical and psychosocial consequences and life style changes inherent in living with a chronic condition. Efficacious self-management encompasses ability to monitor one’s condition and to effect the cognitive, behavioural and emotional responses necessary to maintain a satisfactory quality of life. Thus, a dynamic and continuous process of self-regulation is established [4].

Hence, it is not surprising that the value of self-management interventions that train patients to utilise relevant skills is the subject of increased attention and was mentioned in recent White papers in the UK [5]. Self-management may be one means of bridging the gap between patients’ needs and the capacity of health and social care services to meet those needs.

The purpose of this study was to produce an overview of published literature on self-management in chronic conditions. Objectives were:

  • to identify approaches to self-management;

  • to consider the effectiveness of different approaches to self-management.

Section snippets

Methods

Since there is no ‘gold standard’ definition of self-management, searches were conducted to identify papers that purported to be on self-management. Searches on BIOMED, BIDS (Social Sciences and Science database), CINAHL, MEDLINE, PSYCLIT and Cochrane Library (York, UK) using the key words: ‘self-management and chronic’ yielded a total of 1129 papers (a prior search on ‘self-management and chronic disease’ produced few references).

Inclusion criteria for the overview were (1) report of a

Results

Results are presented under the following headings: chronic conditions, country, self-management approach (e.g. format, content, tutors), outcomes and effectiveness.

Discussion

The largest proportion of the studies included in this overview was published in the 1990s confirming that self-management is a growth area for a number of chronic conditions in many countries around the world. Indeed, in the UK the establishment of the Expert Patients Task Force to investigate the feasibility of self-management interventions is testament to the burgeoning interest at governmental level.

The number of non-RCT studies reporting within-group change over time or process evaluations

Acknowledgements

The authors extend their thanks to the following for their help during the identification and collection of papers for this overview: Michelle Barlow, Kuldeep Kalsi, Suzanne Wright, Dr. L. Wollner, Melanie Peffer from Department of Health, the Long Term Medical Conditions Alliance, National Asthma Campaign, Manic Depression Fellowship and the British Diabetic Association. The paper is based on an overview commissioned by the Department of Health, UK, under remit of the Expert Patients Task

References (149)

  • A.E Bauman et al.

    Removing barriers to effective self-management of asthma

    Patient Educ. Couns.

    (1989)
  • A.C Bernard-Bonnin et al.

    Self-management teaching programs and morbidity of pediatric asthma: a meta-analysis

    J. Allergy Clin. Immunol.

    (1995)
  • N.M Clark et al.

    The effect of health beliefs and feelings of self-efficacy on self-management behavior of children with a chronic disease

    Patient Educ. Couns.

    (1988)
  • V.T Colland

    Learning to cope with asthma: a behavioural self-management program for children

    Patient Educ. Couns.

    (1993)
  • W D’Souza et al.

    Trial of a “credit card” asthma self-management plan in a high-risk group of patients with asthma

    J. Allergy Clin. Immunol.

    (1996)
  • W.D Hendricson et al.

    Implementation of individualized patient education for Hispanic children with asthma

    Patient Educ. Couns.

    (1996)
  • G Maslennikova et al.

    Asthma education programme in Russia: educating patients

    Patient Educ. Couns.

    (1998)
  • E Pettersson et al.

    Evaluation of a nurse-run asthma school

    Int. J. Nurs. Stud.

    (1999)
  • M.M Ratima et al.

    Long-term benefits for Maori of an Asthma Self-Management Program in a Maori community which takes a partnership approach

    Aust. NZ J. Pub. Health

    (1999)
  • V.S Taggart et al.

    You can control asthma: evaluation of an asthma education program for hospitalized inner-city children

    Patient Educ. Couns.

    (1991)
  • K Takabayashi et al.

    Computer-assisted instructions for patients with bronchial asthma

    Patient Educ. Couns.

    (1999)
  • N Tehan et al.

    Impact of asthma self-management education on the health behavior of young adults. A pilot study of the Dartmouth College “Breathe Free” program

    J. Adolesc. Health

    (1989)
  • G.I Town et al.

    A community-wide promotion of asthma self-management in New Zealand

    Patient Educ. Couns.

    (1995)
  • M.I Vazquez et al.

    Effectiveness of self-management programmes and relaxation training in the treatment of bronchial asthma: relationships with trait anxiety and emotional attack triggers

    J. Psychosom. Res.

    (1993)
  • S.R Wilson et al.

    A controlled trial of two forms of self-management education for adults with asthma

    Am. J. Med.

    (1993)
  • M.A Slater et al.

    The clinical significance of behavioral treatment for chronic low back

    Pain

    (1997)
  • M Alderson et al.

    The program for rheumatic independent self-management: a pilot evaluation

    Clin. Rheumatol.

    (1999)
  • H Nakagawa-Kogan et al.

    Self-management of hypertension: predictors of success in diastolic blood pressure reduction

    Res. Nurs. Health

    (1988)
  • N.M Clark et al.

    Self-management of chronic disease by older adults: a review and questions for research

    J. Aging Health

    (1991)
  • Barlow JH. How to use education as an intervention in osteoarthritis. In: Doherty M, Dougados M, editors....
  • Saving lives: our healthier nation. The Department of Health. HMSO, July...
  • D Jenkinson et al.

    Comparison of effects of a self-management booklet and audiocassette for patients with asthma

    Br. Med. J.

    (1988)
  • S.R Wilson et al.

    Education of parents of infants and very young children with asthma: a developmental evaluation of the Wee Wheezers programme

    J. Asthma

    (1996)
  • K Lorig et al.

    Community-based Spanish language arthritis education program: a randomized trial

    Med. Care

    (1999)
  • S.A Brown et al.

    A community-based, culturally sensitive education and group-support intervention for Mexican–Americans with NIDDM: a pilot study of efficacy

    Diabetes Educ.

    (1995)
  • W.C Bailey et al.

    Asthma self-management—do patient education programs always have an impact?

    Arch. Intern. Med.

    (1999)
  • H Kotses et al.

    Evaluation of individualized asthma self-management programs

    J. Asthma

    (1996)
  • K Lorig et al.

    A comparison of lay-taught and professional-taught arthritis self-management courses

    J. Rheumatol.

    (1986)
  • J.L Cohen et al.

    Evaluation of arthritis self-management courses led by lay persons and by professionals

    Arthritis Rheum.

    (1986)
  • J.H Barlow et al.

    A randomised controlled study of the Arthritis Self-Management Programme in the UK

    Health Educ. Res. Theory Practice

    (2000)
  • J.F Fries et al.

    Patient education in arthritis: randomized controlled trial of a mail-delivered program

    J. Rheumatol.

    (1997)
  • I Charlton et al.

    Evaluation of peak flow and symptoms only self-management plans for control of asthma in general practice

    Br. Med. J.

    (1990)
  • A.M Delamater et al.

    Randomized prospective study of self-management training with newly diagnosed diabetic children

    Diabetes Care

    (1990)
  • P.P Horan et al.

    Computer-assisted self-control of diabetes by adolescents

    Diabetes Educ.

    (1990)
  • J.H Barlow et al.

    Long-term outcomes of an Arthritis Self-Management Programme

    Br. J. Rheumatol.

    (1998)
  • J.H Barlow et al.

    Sharing, caring and learning to take control: self-management training for people with arthritis

    Psychol. Health Med.

    (1998)
  • J.H Barlow et al.

    Instilling the strength to fight the pain and get on with life: learning to become an arthritis self-manager through an adult education programme

    Health Educ. Res.

    (1999)
  • C.J Braden

    Patterns of change over time in learned response to chronic illness among participants in a systemic lupus erythematosus self-help course

    Arthritis Care Res.

    (1991)
  • C.S Burckhardt et al.

    A randomized, controlled clinical trial of education and physical training for women with fibromyalgia

    J. Rheumatol.

    (1994)
  • K.R Lorig et al.

    Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs

    Arthritis Rheum.

    (1993)
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