The role of information in supporting self-care in vascular conditions: a conceptual and empirical review

Women's Participation in Self-Care and the Importance of Paying Attention to Cultural Capital: A Cross-Sectional Study among Women in Yazd (Iran)

The present study aimed to investigate the relationship between women's cultural capital and self-care. A survey was employed with a sample size of 737 women living in the marginal, middle, and upper areas of Yazd in terms of socioeconomic characteristics. Data were analyzed using structural equation modelling by SPSS and Amos version 24. The results revealed that the effect of cultural capital on self-care was positive and significant (β = 0.46, p < 0.001). The effectiveness rates of cultural capital on women's self-care in the marginal, middle, and upper areas were 0.44, 0.32 and 0.45, respectively (p < 0.001). Besides, there was no significant difference between the intensity of the relationship between cultural capital and self-care in the three areas (CR < 1.96). The fit indices also indicated that the model had a good fit (CMIN/DF = 2.560, NFI = 0.916, RMSEA = 0.033, CFI = 0.946, TLI = 0.922, GFI = 0.963, IFI = 0.947).

Understanding the Value of Patientview for Enabling Self-Care Practice in Chronic Kidney Disease

BACKGROUND

Individual responsibility and self-care are seen as ways to overcome some of the challenges for long-term health care provision. Patients are being encouraged to take an active role in their health care. Access to health information via a web-based, patient-facing portal is an innovative way to engage in self-care. PatientView is one such portal, which was developed to allow patients with kidney disease access to parts of their health record. It was thought that the use of PatientView would improve self-care activity but there was little evidence to support this claim.

OBJECTIVE

To gain an understanding of how patients with kidney disease use PatientView in their self-care practice.

PARTICIPANTS

Six users and four non-users of PatientView.

DESIGN

Qualitative, semi-structured interviews and participant observation.

APPROACH

A practice-based approach was used to collect qualitative data to better understand how patients use PatientView in daily life to enable self-care. Participants were invited to "show the researcher" how they use PatientView and to describe how they translated the information into actions of self-care. Inductive analysis was used to identify themes.

RESULTS

The analysis identified four key themes, which were non-linear inter-related. Patients engage with PatientView because it supports ways of knowing that are of direct importance to self-care activity. Patients interact with PatientView and translate the information they gain from using it into actions that support self-care. A consequence of engaging with PatientView is that patients can involve their family more in their care and this helps to reduce the burden on health care professionals.

CONCLUSION

Patient interactions with PatientView are inter-related, multi-dimensional and differ according to the individual's positioning within a continuum of care. Nonetheless, these interactions can be captured and doing so provides a basis for understanding of how patients create and sustain opportunities for care through information technology.

The contribution of internet use in personal networks of support for long-term condition self-management

Objectives

To describe the individual and network characteristics of the personal communities of people using the internet and the role of offline support, network resources and community participation in using the internet for condition management.

Methods

Secondary analysis of survey data using logistic regression analysis to determine the factors associated with differential internet use for condition management. This study involved 300 participants from 19 primary care providers in Manchester in 2010 and 2011.

Results

Using the internet is associated with age, deprivation, education and having access to a personal network member who understands how to fix computer problems. Those using the internet for condition management received more offline emotional work. No associations were found between using the internet for health and other types of offline support. Those using the internet for support reported lower levels of happiness.

Conclusion

Network processes and engagement shape online contact and use of resources for condition management. Those with access to personal networks who provide emotional work are likely to make use of online resources during non-crisis situations, suggesting that these resources act as an extension of offline network support. Those with greater levels of unhappiness may more frequently look to the internet for support.

What impact does written information about fatigue have on patients with autoimmune rheumatic diseases? Findings from a qualitative study

OBJECTIVES

Although fatigue is a common symptom for people with rheumatic diseases, limited support is available. This study explored the impact of written information about fatigue, focusing on a booklet, Fatigue and arthritis.

METHODS

Thirteen patients with rheumatic disease and fatigue were recruited purposively from a rheumatology outpatient service. They were interviewed before and after receiving the fatigue booklet. Two patients, plus six professionals with relevant interests, participated in a focus group. Transcripts were analysed thematically and a descriptive summary was produced.

RESULTS

Interviewees consistently reported that fatigue made life more challenging, and none had previously received any support to manage it. Reflecting on the booklet, most said that it had made a difference to how they thought about fatigue, and that this had been valuable. Around half also said that it had affected, or would affect, how they managed fatigue. No one reported any impact on fatigue itself. Comments from interviewees and focus group members alike suggested that the research process may have contributed to the changes in thought and behaviour reported. Its key contributions appear to have been: clarifying the booklet's relevance; prompting reflection on current management; and introducing accountability.

CONCLUSIONS

This study indicated that written information can make a difference to how people think about fatigue and may also prompt behaviour change. However, context appeared to be important: it seems likely that the research process played a part and that the impact of the booklet may have been less if read in isolation. Aspects of the research appearing to facilitate impact could be integrated into routine care, providing a pragmatic (relatively low-cost) response to an unmet need.

How do community pharmacists conceptualise and operationalise self-care support of long-term conditions (LTCs)? An English cross-sectional survey

OBJECTIVES

To explore community pharmacists' contributions to self-care support of long-term conditions by; investigating their conceptual understanding of self-care principles; identifying self-care support activities they considered important and their engagement in them; and examining barriers and enablers.

METHODS

A questionnaire was developed using existing literature and qualitative interviews, piloted and distributed online to a random sample of 10 000 community pharmacists in England between August and November 2014. The questionnaire contained sections addressing the above objectives. Data were analysed using descriptive statistics; free text comments were analysed using content analysis.

KEY FINDINGS

A total of 609 responses were received; 334 completed all sections of the survey. Responses to statements exploring conceptual understanding showed that respondents were more likely to agree with self-care principles about patients taking responsibility and being more actively involved in their health and care; they agreed less with self-care principles promoting patient autonomy and independence. Respondents considered medicines-related self-care support activities as a lead role for community pharmacy, which they said they engaged in regularly. Whilst many agreed that other self-care support activities such as supporting self-monitoring and collaborative care planning were important, they indicated only limited engagement. Respondents identified access to patient records and availability of private consultation rooms as their main barriers and enablers, respectively; working relationship with GPs and skill-mix in community pharmacy were viewed as both barriers and enablers.

CONCLUSIONS

Community pharmacists in this study conceptualised and operationalised self-care support of long-term conditions (LTCs) from a narrow, medicines-focussed perspective, rather than from a multifaceted, patient-focussed perspective. A concerted and coherent strategy that builds on the strengths, and tackles the identified barriers is needed if community pharmacy is to improve contributions to self-care support of LTCs.

Long-Term Condition Self-Management Support in Online Communities: A Meta-Synthesis of Qualitative Papers

Background

Recent years have seen an exponential increase in people with long-term conditions using the Internet for information and support. Prior research has examined support for long-term condition self-management through the provision of illness, everyday, and emotional work in the context of traditional offline communities. However, less is known about how communities hosted in digital spaces contribute through the creation of social ties and the mobilization of an online illness “workforce.”

Objective

The aim was to understand the negotiation of long-term condition illness work in patient online communities and how such work may assist the self-management of long-term conditions in daily life.

Methods

A systematic search of qualitative papers was undertaken using various online databases for articles published since 2004. A total of 21 papers met the inclusion criteria of using qualitative methods and examined the use of peer-led online communities for those with a long-term condition. A qualitative meta-synthesis was undertaken and the review followed a line of argument synthesis.

Results

The main themes identified in relation to the negotiation of self-management support were (1) redressing offline experiential information and knowledge deficits, (2) the influence of modeling and learning behaviors from others on self-management, (3) engagement that validates illness and negates offline frustrations, (4) tie formation and community building, (5) narrative expression and cathartic release, and (6) dissociative anonymity and invisibility. These translated into a line of argument synthesis in which four network mechanisms for self-management support in patient online communities were identified. These were (1) collective knowledge and identification through lived experience; (2) support, information, and engagement through readily accessible gifting relationships; (3) sociability that extends beyond illness; and (4) online disinhibition as a facilitator in the negotiation of self-management support.

Conclusions

Social ties forged in online spaces provide the basis for performing relevant self-management work that can improve an individual’s illness experience, tackling aspects of self-management that are particularly difficult to meet offline. Membership in online groups can provide those living with a long-term condition with ready access to a self-management support illness workforce and illness and emotional support. The substitutability of offline illness work may be particularly important to those whose access to support offline is either limited or absent. Furthermore, such resources require little negotiation online because information and support is seemingly gifted to the community by its members.

Experiences of front-line health professionals in the delivery of telehealth: a qualitative study

BACKGROUND

Telehealth is an emerging field of clinical practice but current UK health policy has not taken account of the perceptions of front-line healthcare professionals expected to implement it.

AIM

To investigate telehealth care for people with long-term conditions from the perspective of the front-line health professional.

DESIGN AND SETTING

A qualitative study in three sites within the UK (Kent, Cornwall, and the London Borough of Newham) and embedded in the Whole Systems Demonstrator evaluation, a large cluster randomised controlled trial of telehealth and telecare for patients with long-term and complex conditions.

METHOD

Semi-structured qualitative interviews with 32 front-line health professionals (13 community matrons, 10 telehealth monitoring nurses and 9 GPs) involved in the delivery of telehealth. Data were analysed using a modified grounded theory approach.

RESULTS

Mixed views were expressed by front-line professionals, which seem to reflect their levels of engagement. It was broadly welcomed by nursing staff as long as it supplemented rather than substituted their role in traditional patient care. GPs held mixed views; some gave a cautious welcome but most saw telehealth as increasing their work burden and potentially undermining their professional autonomy.

CONCLUSION

Health care professionals will need to develop a shared understanding of patient self-management through telehealth. This may require a renegotiation of their roles and responsibilities.

A scoping review to understand the effectiveness of linking schemes from healthcare providers to community resources to improve the health and well-being of people with long-term conditions

The prevalence of people living with long-term conditions is increasing, accompanied by an increased expectation that patients will become more involved in self-management. Long-term conditions are associated with increased social isolation and poor physical and mental health. But there remains a gap in health provision between providing medical treatment and effectively addressing psychosocial well-being. One potential way of addressing this gap is by utilising social interventions which link patients from health services to community-based sources of support. However, the mechanisms involved in the delivery of interventions providing that link and their effectiveness remain unclear. This review adopted the methodological framework for conducting scoping studies, searching for both academic and grey literature on social interventions which link people from healthcare settings to a range of community and voluntary sector organisations. A literature search between May and June 2013, involving five electronic databases, hand searching of two journals and the use of Google search engine, identified seven studies relevant to the review question. In terms of key characteristics and mechanisms of the interventions, mental health conditions and social isolation were the most common reasons for referral to the interventions, and referrals were usually made through general practices. Almost all the interventions were facilitator-led, whereby the facilitator worked to identify and link participants to appropriate community-based resources. In regard to health and social outcomes and their cost-effectiveness, studies reported improvement to participants' psychological and social well-being as well as their decreased use of health services, although there were limited measures of participants' physical health outcomes. Interventions for linking patients from healthcare setting to community-based resources target and address psychosocial needs of participants. The review identified involvement of health professionals in aiding the referral of patients to the intervention and the role of the intervention facilitators as key components of the interventions.

Illness beliefs and the sociocultural context of diabetes self-management in British South Asians: a mixed methods study

Background

British South Asians have a higher incidence of diabetes and poorer health outcomes compared to the general UK population. Beliefs about diabetes are known to play an important role in self-management, yet little is known about the sociocultural context in shaping beliefs. This study aimed to explore the influence of sociocultural context on illness beliefs and diabetes self-management in British South Asians.

Methods

A mixed methods approach was used. 67 participants recruited using random and purposive sampling, completed a questionnaire measuring illness beliefs, fatalism, health outcomes and demographics; 37 participants completed a social network survey interview and semi-structured interviews. Results were analysed using SPSS and thematic analysis.

Results

Quantitative data found certain social network characteristics (emotional and illness work) were related to perceived concern, emotional distress and health outcomes (p < 0.05). After multivariate analysis, emotional work remained a significant predictor of perceived concern and emotional distress related to diabetes (p < 0.05). Analysis of the qualitative data suggest that fatalistic attitudes and beliefs influences self-management practices and alternative food ‘therapies’ are used which are often recommended by social networks.

Conclusions

Diabetes-related illness beliefs and self-management appear to be shaped by the sociocultural context. Better understanding of the contextual determinants of behaviour could facilitate the development of culturally appropriate interventions to modify beliefs and support self-management in this population.

Electronic supplementary material

The online version of this article (doi:10.1186/s12875-015-0269-y) contains supplementary material, which is available to authorized users.

Self-management support from the perspective of patients with a chronic condition: a thematic synthesis of qualitative studies

BACKGROUND

Receiving adequate support seems to be crucial to the success of self-management. Although different empirical studies separately examined patients' preferences for self-management support (SMS), an overview is lacking.

OBJECTIVE

The aim of this qualitative review was to identify patients' needs with respect to SMS and to explore by whom this support is preferably provided.

SEARCH STRATEGY

Qualitative studies were identified from Embase, MEDLINE OvidSP, Web of science, PubMed publisher, Cochrane central, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO.

INCLUSION CRITERIA

Articles needed to meet all of the following criteria: (i) focuses on self-management, (ii) concerns adult patients with rheumatic diseases (rheumatoid arthritis and fibromyalgia), a variant of cancer or chronic kidney disease, (iii) explores support needs from the patients' perspective, (iv) uses qualitative methods and (v) published in English.

DATA EXTRACTION AND SYNTHESIS

A thematic synthesis, developed by Thomas and Harden, was conducted of the 37 included studies.

MAIN RESULTS

Chronic patients need instrumental support, psychosocial support and relational support from health-care professionals, family/friends and fellow patients to manage the chronic condition. Relational support is at the centre of the support needs and fuels all other types of support.

DISCUSSION AND CONCLUSIONS

Patients do not self-manage on their own. Patients expect health-care professionals to fulfil a comprehensive role. Support needs can be knitted together only when patients and professionals work together on the basis of collaborative partnership. Dynamics in support needs make it important to regularly assess patient needs.

Dynamics and nature of support in the personal networks of people with type 2 diabetes living in Europe: qualitative analysis of network properties

BACKGROUND

Living with and self-managing a long-term condition implicates a diversity of networked relationships. This qualitative study examines the personal communities of support of people with type 2 diabetes.

METHODS

We conducted 170 biographical interviews in six European countries (Bulgaria, Greece, the Netherlands, Norway, Spain and UK) to explore social support and networks. Analysis was framed with reference to three predetermined social support mechanisms: the negotiation of support enabling engagement with healthy practices, navigation to sources of support and collective efficacy. Each interview was summarized to describe navigation and negotiation of participants' networks and the degree of collective efficacy.

RESULTS

Analysis highlighted the similarities and differences between countries and provided insights into capacities of networks to support self-management. The network support mechanisms were identified in all interviews, and losses and gains in networks impacted on diabetes management. There were contextual differences between countries, most notably the impact of financial austerity on network dynamics. Four types of network are suggested: generative, diverse and beneficial to individuals; proxy, network members undertook diabetes management work; avoidant, support not engaged with; and struggling, diabetes management a struggle or not prioritized.

CONCLUSIONS

It is possible to differentiate types of network input to living with and managing diabetes. Recognizing the nature of active, generative aspects of networks support is likely to have relevance for self-management support interventions either through encouraging continuing development and maintenance of these contacts or intervening to address struggling networks through introducing the means to connect people to additional sources of support.

Implementation of a self-management support approach (WISE) across a health system: a process evaluation explaining what did and did not work for organisations, clinicians and patients

BACKGROUND

Implementation of long-term condition management interventions rests on the notion of whole systems re-design, where incorporating wider elements of health care systems are integral to embedding effective and integrated solutions. However, most self-management support (SMS) evaluations still focus on particular elements or outcomes of a sub-system. A randomised controlled trial of a SMS intervention (WISE-Whole System Informing Self-management Engagement) implemented in primary care showed no effect on patient-level outcomes. This paper reports on a parallel process evaluation to ascertain influences affecting WISE implementation at patient, clinical and organisational levels. Normalisation Process Theory (NPT) provided a sensitising background and analytical framework.

METHODS

A multi-method approach using surveys and interviews with organisational stakeholders, practice staff and trial participants about impact of training and use of tools developed for WISE. Analysis was sensitised by NPT (coherence, cognitive participation, collective action and reflective monitoring). The aim was to identify what worked and what did not work for who and in what context.

RESULTS

Interviews with organisation stakeholders emphasised top-down initiation of WISE by managers who supported innovation in self-management. Staff from 31 practices indicated engagement with training but patchy adoption of WISE tools; SMS was neither prioritised by practices nor fitted with a biomedically focussed ethos, so little effort was invested in WISE techniques. Interviews with 24 patients indicated no awareness of any changes following the training of practice staff; furthermore, they did not view primary care as an appropriate place for SMS.

CONCLUSION

The results contribute to understanding why SMS is not routinely adopted and implemented in primary care. WISE was not embedded because of the perceived lack of relevance and fit to the ethos and existing work. Enacting SMS within primary care practice was not viewed as a legitimate activity or a professional priority. There was failure to, in principle, engage with and identify patients' support needs. Policy presumptions concerning SMS appear to be misplaced. Implementation of SMS within the health service does not currently account for patient circumstances. Primary care priorities and support for SMS could be enhanced if they link to patients' broader systems of implementation networks and resources.

Diabetes self-management arrangements in Europe: a realist review to facilitate a project implemented in six countries

Background

Self-management of long term conditions can promote quality of life whilst delivering benefits to the financing of health care systems. However, rarely are the meso-level influences, likely to be of direct relevance to these desired outcomes, systematically explored. No specific international guidelines exist suggesting the features of the most appropriate structure and organisation of health care systems within which to situate self-management approaches and practices. This review aimed to identify the quantitative literature with regard to diabetes self-management arrangements currently in place within the health care systems of six countries (The United Kingdom, The Netherlands, Norway, Spain, Bulgaria, and Greece) and explore how these are integrated into the broader health care and welfare systems in each country.

Methods

The methodology for a realist review was followed. Publications of interest dating from 2000 to 2013 were identified through appropriate MeSH terms by a systematic search in six bibliographic databases. A search diary was maintained and the studies were assessed for their quality and risk of bias.

Results

Following the multi-step search strategy, 56 studies were included in the final review (the majority from the UK) reporting design methods and findings on 21 interventions and programmes for diabetes and chronic disease self-management. Most (11/21, 52%) of the interventions were designed to fit within the context of primary care. The majority (11/21, 52%) highlighted behavioural change as an important goal. Finally, some (5/21, 24%) referred explicitly to Internet-based tools.

Conclusions

This review is based on results which are derived from a total of at least 5,500 individuals residing in the six participating countries. It indicates a policy shift towards patient-centred self-management of diabetes in a primary care context. The professional role of diabetes specialist nurses, the need for multidisciplinary approaches and a focus on patient education emerge as fundamental principles in the design of relevant programmes. Socio-economic circumstances are relevant to the capacity to self-manage and suggest that any gains and progress will be hard to maintain during economic austerity. This realist review should be interpreted within the wider context of a whole systems approach regarding self-care support and chronic illness management.

Electronic supplementary material

The online version of this article (doi:10.1186/1472-6963-14-453) contains supplementary material, which is available to authorized users.

Developing cartoons for long-term condition self-management information

BACKGROUND

Advocating the need to adopt more self-management policies has brought with it an increasing demand for information about living with and making decisions about long-term conditions, with a significant potential for using cartoons. However, the purposeful use of cartoons is notably absent in many areas of health care as is evidence of their acceptability to patients and lay others. This paper outlines the process used to develop and evaluate cartoons and their acceptability for a series of self-management guidebooks for people with inflammatory bowel disease, irritable bowel syndrome, diabetes, chronic obstructive pulmonary disease and chronic kidney disease (CKD).

METHODS

Principles for a process to develop information and cartoons were developed. Cartoon topics were created using qualitative research methods to obtain lay views and experiences. The CKD guidebook was used to provide a detailed exemplar of the process. Focus group and trial participants were recruited from primary care CKD registers. The book was part of a trial intervention; selected participants evaluated the cartoons during in-depth interviews which incorporated think-aloud methods.

RESULTS

In general, the cartoons developed by this process depict patient experiences, common situations, daily management dilemmas, making decisions and choices and the uncertainties associated with conditions. CKD cartoons were developed following two focus groups around the themes of getting a diagnosis; understanding the problem; feeling that facts were being withheld; and setting priorities. Think-aloud interviews with 27 trial participants found the CKD cartoons invoked amusement, recognition and reflection but were sometimes difficult to interpret.

CONCLUSION

Humour is frequently utilised by people with long-term conditions to help adjustment and coping. Cartoons can help provide clarity and understanding and could address concerns related to health literacy. Using cartoons to engage and motivate people is a consideration untapped by conventional theories with the potential to improve information to support self-management.

Neighborhood social capital, neighborhood attachment, and dental care use for Los Angeles Family and Neighborhood Survey adults

OBJECTIVES

We tested the hypothesis that neighborhood-level social capital and individual-level neighborhood attachment are positively associated with adult dental care use.

METHODS

We analyzed data from the 2000-2001 Los Angeles Family and Neighborhood Survey that were linked to US Census Bureau data from 2000 (n = 1800 adults aged 18-64 years across 65 neighborhoods). We used 2-level hierarchical logistic regression models to estimate the odds of dental use associated with each of 4 forms of social capital and neighborhood attachment.

RESULTS

After adjusting for confounders, the odds of dental use were significantly associated with only 1 form of social capital: social support (adjusted odds ratio [AOR] = 0.85; 95% confidence interval [CI] = 0.72, 0.99). Individual-level neighborhood attachment was positively associated with dental care use (AOR = 1.05; 95% CI = 1.01, 1.10).

CONCLUSIONS

Contrary to our hypothesis, adults in neighborhoods with higher levels of social capital, particularly social support, were significantly less likely to use dental care. Future research should identify the oral health-related attitudes, beliefs, norms, and practices in neighborhoods and other behavioral and cultural factors that moderate and mediate the relationship between social capital and dental care use.

The clinical and cost-effectiveness of the BRinging Information and Guided Help Together (BRIGHT) intervention for the self-management support of people with stage 3 chronic kidney disease in primary care: study protocol for a randomized controlled trial

Background

Improving the quality of care for people with vascular disease is a key priority. Chronic kidney disease (CKD) has recently been included as a target condition for general practices to add to registers of chronic conditions as part of the Quality and Outcome Framework. This paper outlines the implementation and evaluation of a self-management intervention involving an information guidebook, tailored access to local resources and telephone support for people with stage 3 chronic kidney disease.

Methods/Design

The study involves a multi-site, longitudinal patient-level randomized controlled trial. The study will evaluate the clinical use and cost-effectiveness of a complex self-management intervention for people with stage 3 chronic kidney disease in terms of self-management capacity, health-related quality of life and blood pressure control compared to care as usual. We describe the methods of the patient-level randomized controlled trial.

Discussion

The management of chronic kidney disease is a developing area of research. The BRinging Information and Guided Help Together (BRIGHT) trial aims to provide evidence that a complementary package of support for people with vascular disease that targets both clinical and social need broadens the opportunities of self-management support by addressing problems related to social disadvantage.

Trial registration

Trial registration reference: ISRCTN45433299

Prevalence and associations of limited health literacy in chronic kidney disease: a systematic review

BACKGROUND

Health literacy (HL) is important in chronic disease. This review aimed to evaluate the literature evidence on prevalence and associations of limited HL in chronic kidney disease (CKD).

METHODS

Seven databases were searched using terms for CKD and HL. Studies were included that ascertained the prevalence of limited HL using a validated tool in adults with CKD of any stage. The primary outcome was an objectively measured prevalence of limited HL in a population with CKD. The secondary outcome was associations of limited HL. Two reviewers assessed study inclusion and quality. Prevalence values were combined using a random-effect model to give overall prevalence.

RESULTS

Eighty-two studies were identified from searching, of which six met the inclusion criteria. The total number of people in all studies was 1405. Five studies were in dialysis or transplant populations, and all were from the USA. There was a significant heterogeneity in the prevalence of limited HL [9-32% (median 25%, inter-quartile range 16%)]. The pooled prevalence of limited HL in all studies was 22.7% (95% confidence interval 20.6-24.8%), but study heterogeneity limited the generalizability of this combined prevalence. The review identified associations between limited HL and socio-economic factors (lower education attainment, lower income), and certain process and outcome measures (lower likelihood of referral for transplant, higher mortality).

CONCLUSIONS

Limited HL is common among people with CKD and independently associated with socio-economic factors and health outcomes. It may represent an important determinant of inequality in CKD.

Social networks, work and network-based resources for the management of long-term conditions: a framework and study protocol for developing self-care support

BACKGROUND

Increasing the effective targeting and promotion of self-care support for long-term conditions requires more of a focus on patient contexts and networks. The aim of this paper is to describe how within a programme of research and implementation, social networks are viewed as being centrally involved in the mobilisation and deployment of resources in the management of a chronic condition. This forms the basis of a novel approach to understanding, designing, and implementing new forms of self-management support.

METHODS

Drawing on evidence syntheses about social networks and capital and the role of information in self-management, we build on four conceptual approaches to inform the design of our research on the implementation of self-care support for people with long-term conditions. Our approach takes into consideration the form and content of social networks, notions of chronic illness work, normalisation process theory (NPT), and the whole systems informing self-management engagement (WISE) approach to self-care support.

DISCUSSION

The translation and implementation of a self-care agenda in contemporary health and social context needs to acknowledge and incorporate the resources and networks operating in patients' domestic and social environments and everyday lives. The latter compliments the focus on healthcare settings for developing and delivering self-care support by viewing communities and networks, as well as people suffering from long-term conditions, as a key means of support for managing long-term conditions. By focusing on patient work and social-network provision, our aim is to open up a second frontier in implementation research, to translate knowledge into better chronic illness management, and to shift the emphasis towards support that takes place outside formal health services.