Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

Supporting chronic disease self-management: translating policies and principles into clinical practice

Rosemary Higgins A D , Barbara Murphy A B , Marian Worcester A B and Angela Daffey C

A Heart Research Centre, Box 2137, Royal Melbourne Hospital, Melbourne, Vic. 3050, Australia.

B Department of Psychiatry, The University of Melbourne, Level 1, North Main Block, Royal Melbourne Hospital, Melbourne, Vic. 3050, Australia.

C Department of Psychology and Psychiatry, Building 17, Clayton Campus, Monash University, Wellington Road, Vic. 3800, Australia.

D Corresponding author. Email: rosemary.higgins@heartresearchcentre.org

Australian Journal of Primary Health 18(1) 80-87 http://dx.doi.org/10.1071/PY11006
Submitted: 24 January 2011  Accepted: 26 May 2011   Published: 21 October 2011

Abstract

To support self-management, health professionals need to adopt a client-centred approach and learn to deliver evidence-based behaviour change interventions. This paper reports on the evaluation of 1- and 2-day training programs developed to improve health professionals’ capacity to support chronic disease self-management (CDSM). The 321 participants attended one of eighteen supporting CDSM courses held in urban and rural settings. Participants included nurses, allied health professionals, Aboriginal health workers and general practitioners. Data were collected at three time points: before participation; immediately after the training; and, for a sub-sample of 37 participants, 2 months after the training. Results revealed a significant and sustained increase in CDSM self-efficacy following training regardless of participants’ gender, age or qualifications. A thematic analysis of the responses concerning intended practice revealed four main areas of intended practice change, namely: use behavioural strategies; improve communication with clients; adopt a client-centred approach; and improve goal setting. The number of practice changes at 2 months reported by a sub-sample of participants ranged from 1 to 20 with a mean of 14 (s.d. = 4). The three most common areas of practice change point to the adoption by health professionals of a collaborative approach with chronic disease patients. Lack of staff trained in CDSM was seen as a major barrier to practice change, with lack of support and finance also named as barriers to practice change. Participants identified that increased training, support and awareness of the principles of supporting CDSM would help to overcome barriers to practice change. These results indicate a readiness among health professionals to adopt a more collaborative approach given the skills and the tools to put this approach into practice.


References

Anderson C, Bischoff K, Fulton N, Stone G (2009) Perth metropolitan area mapping of chronic disease self management programs, and gap analysis report 2008 . Department of Health, Western Australia.

Australian Institute of Health and Welfare (2006) ‘Chronic diseases and associated risk factors in Australia.’ (Australian Institute of Health and Welfare: Canberra)

Australian Institute of Health and Welfare (2007) ‘Older Australia at a glance.’ (Australian Institute of Health and Welfare: Canberra)

Bandura A (1977) Self-efficacy: toward a unifying theory of behavioral change. Psychological Review 84, 191–215.
Self-efficacy: toward a unifying theory of behavioral change.CrossRef | 1:STN:280:DyaE2s7kvFCisQ%3D%3D&md5=8fc19a27406f89e361057a4a9c3567baCAS | 847061PubMed | open url image1

Bandura A (1991) Social cognitive theory of self-regulation. Organizational Behavior and Human Decision Processes 50, 248–287.
Social cognitive theory of self-regulation.CrossRef | open url image1

Bodenheimer T, Lorig K, Holman H, Grumbach K (2002) Patient self-management of chronic disease in primary care. Journal of the American Medical Association 288, 2469–2475.
Patient self-management of chronic disease in primary care.CrossRef | 12435261PubMed | open url image1

Clark M, Hampson S (2001) Implementing a psychological intervention to improve lifestyle self-management in patients with Type 2 diabetes. Patient Education and Counseling 42, 247–256.
Implementing a psychological intervention to improve lifestyle self-management in patients with Type 2 diabetes.CrossRef | 1:STN:280:DC%2BD38%2Fgs1Ortg%3D%3D&md5=114f3f34b20ee3a836685d041216e5f6CAS | 11164324PubMed | open url image1

Cope K, Highland J (2009) Assessment of chronic illness care – great tool to instigate change in chronic care. Paper presented at the 3rd Rural Health Research Colloquium. 27–29 October, Ballina, NSW.

Dysvik E, Kvaloy JT, Stokkeland R, Natvig GK (2010) The effectiveness of a multidisciplinary pain management programme managing chronic pain on pain perceptions, health-related quality of life and stages of change – a non-randomized controlled study. International Journal of Nursing Studies 47, 826–835.
The effectiveness of a multidisciplinary pain management programme managing chronic pain on pain perceptions, health-related quality of life and stages of change – a non-randomized controlled study.CrossRef | 20036362PubMed | open url image1

Elliott P, Higgins R, Furber G (2009) ‘Supporting chronic disease self management: a workbook for lifestyle change.’ (Heart Research Centre: Melbourne)

Ford M, Martin RD, Hilton LW, Ewert-Flannagan T, Corrigan GK, Johnson G, Hemandez MA, Sbach A, Lippman SM (1997) Outcomes study of a course in breast-cancer screening. Journal of Cancer Education 12, 179–184.

Gruman J, Von Korff M (1996) ‘Indexed bibliography on self-management for people with chronic disease.’ (Centre for Advancement in Health: Washington DC)

Holman H, Lorig K (2004) Patient self-management: a key to effectiveness and efficacy in care of chronic disease. Public Health Reports 119, 239–243.
Patient self-management: a key to effectiveness and efficacy in care of chronic disease.CrossRef | 15158102PubMed | open url image1

Kaye W, Mancini M, Rallis S (1987) Advanced cardiac life support refresher course using standardized objective-based Mega Code testing. Critical Care Medicine 15, 55–60.
Advanced cardiac life support refresher course using standardized objective-based Mega Code testing.CrossRef | 1:STN:280:DyaL2s%2FnvFKgtw%3D%3D&md5=a829f88265ef48c8a761a81b5b15e3fcCAS | 3792016PubMed | open url image1

Lawn S, Battersby M (2009) ‘Capabilities for supporting prevention and chronic condition self-management: a resource for educators of primary health care professionals.’ (Commonwealth of Australia: Canberra)

Lisspers J, Sundin O, Hofman-Bang C, Nordlander R, Nygren A, Ryden L, Öhman A (1999) Behavioural effects of a comprehensive, multifactorial program for lifestyle changes after percutaneous transluminal coronary angioplasty: a prospective, randomized, controlled study. Journal of Psychosomatic Research 46, 143–154.
Behavioural effects of a comprehensive, multifactorial program for lifestyle changes after percutaneous transluminal coronary angioplasty: a prospective, randomized, controlled study.CrossRef | 1:STN:280:DyaK1M7ps1Cmuw%3D%3D&md5=1ed45e7235db220184159b3b246dd080CAS | 10098823PubMed | open url image1

Lorenz R, Gregory R, Davis D (2000) Utility of a brief self-efficacy scale in clinical training program evaluation. Evaluation & the Health Professions 23, 182–193.
Utility of a brief self-efficacy scale in clinical training program evaluation.CrossRef | 1:STN:280:DC%2BD3M%2FgsVGjug%3D%3D&md5=8d4630493dfe755d91205d4dfa7bf186CAS | open url image1

Moss-Morris R, McAlpine L, Didsbury LP, Spence MJ (2010) A randomized controlled trial of a cognitive behavioural therapy-based self-management intervention for irritable bowel syndrome in primary care. Psychological Medicine 40, 85–94.
A randomized controlled trial of a cognitive behavioural therapy-based self-management intervention for irritable bowel syndrome in primary care.CrossRef | 1:STN:280:DC%2BD1Mjps1amuw%3D%3D&md5=736ae8714ddd1a03e8d7c8675825de5eCAS | 19531276PubMed | open url image1

National Health Priority Action Council (2006) ‘National chronic disease strategy.’ (Australian Government Department of Health and Ageing: Canberra)

Posavac E, Carey R (1997) ‘Program evaluation: methods and case studies.’ 5th edn. (Prentice Hall: Englewood Cliffs, NJ)

Price V, Murphy S, Cureton V (2004) Increasing self-efficacy and knowledge through a seizure education program for special education teachers. The Journal of School Nursing 20, 43–49.
Increasing self-efficacy and knowledge through a seizure education program for special education teachers.CrossRef | 14731106PubMed | open url image1

Qureshi KA, Gershon R, Merrill J, Calero-Breckheimer A, Murrman M, Gebbie KM, Moskin LC, May L, Morse SS, Sherman M (2004) Effectiveness of an emergency preparedness training program for public health nurses in New York City. Family & Community Health 27, 242–249.

Strauss A, Corbin A (1991) ‘Basics of qualitative research: grounded theory procedures and techniques.’ (Sage Publications: Newbury Park, CA)

Wagner EH (1998) What will it take to improve care for chronic illness? Effective Clinical Practice 1, 2–4.

Worcester M (1986) ‘Cardiac rehabilitation programmes in Australian hospitals.’ (National Heart Foundation of Australia: Melbourne)



Export Citation Cited By (8)