This project is funded by the Health Foundation. It aims to develop an account of professional support for self-management that can reflect and help promote meaningfully good practice in diverse health and social care contexts. It is an exercise in practical philosophy that draws on existing literature, incorporates primary research to investigate health professionals’ perspectives on success and collaboration in their work with people with long-term conditions, and uses a series of knowledge exchange events to test and refine ways of thinking and talking about the purpose and processes of support for self-management.
During the course of the project, we have drawn a distinction between support oriented to enable people to manage their long-term conditions well and support oriented to enable people to manage well with their long-term conditions. We have developed an explanation of why and how approaches to support for self-management that are narrowly oriented to educate and motivate people to adopt behaviours recommended for disease control can undermine the positive ambitions of the concept. We have also developed an argument that support for people with long-term conditions should be oriented towards enabling them to live (and die) well with those conditions, and we have outlined some theoretical advantages of using a capabilities approach to thinking about living well.
We have recognised that the idea that support for self-management should be oriented to enable people to live well with their long-term conditions makes the purpose of professional practice more open-ended and contestable than is sometimes assumed. This was reflected in the interviews with health professionals: their reflections on success in their work with people with long-term conditions also highlighted important limitations of various indicators of the quality of care.
Our analysis of the interviews also highlight the various uncertainties and tensions that health professionals have to navigate as they strive to work with people in less than ideal circumstances in pursuit of the multiple goods that living well can encompass. It suggests a need for professional education and continuing professional development initiatives to attend more explicitly to the balancing of values inherent to person-centred support.
Vikki Entwistle; firstname.lastname@example.org
Morgan HM, Entwistle VA, Cribb A, Christmas S, Owens J, Skea Z, Watt I. "We need to talk about purpose": a critical interpretive synthesis of health and social care professionals' approaches to self-management support for people with long-term conditions. Health Expectations, 2017; 20(2): 243-259. DOI: 10.1111/hex.12453
Owens J, Entwistle VA, Cribb A, Skea ZC, Christmas S, Morgan H, Watt IS. ‘Was that a success or not a success?’ A qualitative study of health professionals’ perspectives on support for people with long-term conditions. BMC Family Practice, 2017; 18:39. DOI 10.1186/s12875-017-0611-7
Entwistle VA, Cribb A, Owens J. Why health and social care support for people with long-term conditions should be oriented towards enabling them to live well. Health Care Analysis, 2018, 26(1): 48-65. DOI 10.1007/s10728-016-0335-1.
Entwistle VA, Cribb A, Watt IS, Skea ZC, Owens J, Morgan H, Christmas S. “The more you know, the more you realise it is really challenging to do”: tensions and uncertainties in ‘person-centred’ support for people with long-term conditions. Patient Education and Counselling, 2018; 101 (8): 1460-7, https://doi.org/10.1016/j.pec.2018.03.028.