Looking after yourself : Clinical understandings of chronic-care self-management strategies in rural and urban contexts of the United Kingdom and Australia
Description:
Objectives: This article reports on the outcomes of two similar projects undertaken during 2011–2012 in Australia (Rural Northern New South Wales) and the United Kingdom (Urban Northern United Kingdom) that sought to identify the strategies that health professionals employ to actively involve patients with chronic conditions in the planning and delivery of their care. In particular, this study explored understandings and contexts of care that impacted on the participants’ practices. This study was informed by the global shift to partnership approaches in health policy and the growing imperative to deliver patient or client-centred care. Methods: An ethnomethodological design was used, as ethnomethodology does not dictate a set of research methods or procedures, but rather is congruent with any method that seeks to explore what people do in their routine everyday lives. Focus groups and interviews were employed to explore the strategies used by a range of primary health-care providers, such as general practitioners, nurses, social workers, diabetes educators, dieticians and occupational therapists, to support clients to effectively manage their own chronic conditions. Results: Data from both studies were synthesised and analysed thematically, with the themes reflecting the context, similarities and differences of the two studies that the participants felt had either facilitated or blocked their efforts to support their clients to adopt self-care strategies. Conclusion: Supporting patients/clients to engage in actively self-managing their health-care needs requires changes to clients’ and clinicians’ traditional perspectives on their roles. The barriers and enablers to supporting clients to manage their own health needs were similar across both locations and included tensions in role identity and functions, the discourse of health-care professionals as ‘experts’ who deliver care and their level of confidence in being facilitators who ‘educate’ clients to effectively manage their health-care needs, rather than only the ‘providers’ of care.
Description:
Objectives: This article reports on the outcomes of two similar projects undertaken during 2011–2012 in Australia (Rural Northern New South Wales) and the United Kingdom (Urban Northern United Kingdom) that sought to identify the strategies that health professionals employ to actively involve patients with chronic conditions in the planning and delivery of their care. In particular, this study explored understandings and contexts of care that impacted on the participants’ practices. This study was informed by the global shift to partnership approaches in health policy and the growing imperative to deliver patient or client-centred care. Methods: An ethnomethodological design was used, as ethnomethodology does not dictate a set of research methods or procedures, but rather is congruent with any method that seeks to explore what people do in their routine everyday lives. Focus groups and interviews were employed to explore the strategies used by a range of primary health-care providers, such as general practitioners, nurses, social workers, diabetes educators, dieticians and occupational therapists, to support clients to effectively manage their own chronic conditions. Results: Data from both studies were synthesised and analysed thematically, with the themes reflecting the context, similarities and differences of the two studies that the participants felt had either facilitated or blocked their efforts to support their clients to adopt self-care strategies. Conclusion: Supporting patients/clients to engage in actively self-managing their health-care needs requires changes to clients’ and clinicians’ traditional perspectives on their roles. The barriers and enablers to supporting clients to manage their own health needs were similar across both locations and included tensions in role identity and functions, the discourse of health-care professionals as ‘experts’ who deliver care and their level of confidence in being facilitators who ‘educate’ clients to effectively manage their health-care needs, rather than only the ‘providers’ of care.
Description:
This paper reports on the outcomes of a two related projects undertaken during 2011-2012 in Australia (Rural Northern NSW) and the UK (Urban Northern UK) that sought to identify the strategies that clinicians employ to actively involve patients with chronic conditions in the planning and delivery of their care1,2,8. This study was informed by the global shift to partnership approaches in health policy and the growing imperative to deliver patient or client-centred care3,4,9,10. Support for self-management refers to the role that clinicians play in building client knowledge, skill and confidence to effectively manage their own healthcare concerns and treatments6. A qualitative methodology was used, with focus groups and interviews conducted to explore the strategies used by a range of primary healthcare providers, such as general practitioners, nurses, social workers, diabetes educators, dieticians and occupational therapists, to support clients to effectively manage their own chronic conditions. In particular this study aimed to understand the models and contexts of care that impacted on the participants’ practices and identify barriers and enablers to supporting client self-management from the participants’ perspective5,7. This paper presents the results of these studies and identifies the similarities and differences between the two contexts that have either facilitated or blocked clinicians’ efforts to support their clients to adopt self-care strategies7. We are not claiming national commentaries but are drawing on two studies that we consider provide insight into ‘typical’ practices in both countries. The finding of both studies identified that supporting patients/clients to engage in actively managing their health care needs requires changes to client and clinicians traditional perspectives on their role, practice and education, as well as developing more integrated health policies to better support clients with complex health care needs, who want to adopt self-management practices.
Description:
Improving the health of Traveller Communities is an international public health concern but there is little evidence on effective interventions. This study aimed to explain how, for whom and in what circumstances outreach works in Traveller Communities. A realist synthesis was undertaken. Systematic literature searches were conducted between August and November 2011. Grey literature was sought and key stakeholders were involved throughout the review process. Iterative steps of data extraction, analysis and synthesis, followed by additional searches were undertaken. An explanatory framework details how, why and in what circumstances participation, behaviour change or social capital development happened. The trust status of outreach workers is an important context of outreach interventions, in conjunction with their ability to negotiate the intervention focus. The higher the outreach worker's trust status, the lower the imperative that they negotiate the intervention focus. A 'menu' of reasoning mechanisms is presented, leading to key engagement outcomes. Adopting a realist analysis, this study offers a framework with explanatory purchase as to the potential of outreach to improve health in marginalized groups.