Self Management: Evidence and Theoretical Components

Module 4.
Self management
Evidence and theoretical
components
Produced by The Alfred Workforce Development Team

on behalf of DHS Public Health -
Diabetes Prevention and Management Initiative
June 2005
Presentation purpose
Target audience
 Service providers and project workers on DPMI projects

Aim
 To encourage consumers to self manage
Objectives
 Provide an overview of the concepts of self management
 Review self management programs and evidence
 Explore the components of self management and integration into
practice.
DPMI Workforce Development – The Alfred Workforce Development Team June 2005
What is self management?
 Self-management is the active participation by

people in their own healthcare.
 Self-management incorporates:
 health promotion and risk reduction
 informed decision making
 following care plans
 medication management
 working with health care providers to attain the best
possible care and to effectively negotiate the often
complex health system.
National Chronic Disease Strategy (Draft) National Health Priority

Action Council www.nhpac.gov.au
Is self management effective?
 Evidence to support self

management
 Improves quality of life
 Supports behavior change
 Decreases health care

utilisation
References
 Barlow J. et a “Self – management

approaches for people with chronic
conditions: a review” Patient Education
and Counseling 48 (2002) 177-187
 “Patients as effective collaborators in
managing chronic conditions”
www.cfah.org.au
 Adherence to long term therapies
www.who.org go to publications link
Diabetes self management education
in Australia
 Norsworthy document reviewed
 8 articles in which the authors reviewed up to 153
studies of the effectiveness of diabetes
interventions.
 Each of the studies concludes that diabetes self
management education is effective in improving
health outcomes for people living with diabetes.
 influence behaviour change and improve knowledge and
skill for diabetes self management
 reductions in secondary complication rates
 reducing reliance on health services.
Ann Nosworthy April 2004 ADEA. www.adea.org.au

Measuring effectiveness of self
management
 Self-management Education Programs in
Chronic Disease-A Systematic Review and
Methodological Critique of the Literature
 Conclusions:
 Self-management education programs resulted in
small to moderate effects for selected chronic
diseases as measured by clinical markers. ( diabetes,
hypertension and asthma)
 Need to adhere to a standard methodology to help clarify
whether self-management education is worthwhile.
Asra Warsi,et al. Arch Intern Med. 2004;164:1641-1649
Stanford Chronic Disease Self
Management Program
 RCT - 952 subjects
 Demographic Data
 Age 62 years
 Male 27%
 Education 14 years
 No. Diseases 2.2
Kate Lorig et al. Evidence suggesting that a chronic disease self management program
can improve health status while reducing hospitalizations. Medical Care 37,1 1999
Management Program
 Percent With Common Diseases
 Lung Disease 21%
 Heart Disease 24%
 Diabetes 26%
 Arthritis 42%
Management Program
 6-Month Improvements in Health
Outcomes
 Self-Rated Health
• Disability
• Social and Role Activities Limitations
• Energy/Fatigue
• Distress with Health State
Management Program
 Improvements in utilisation and costs

 Average 0.8 fewer days in hospital in the past
six months (p=.02)
 Trend toward fewer outpatient and ER visits
(p=.14)
 Estimated cost of intervention $100-$200
http://patienteducation.stanford.edu/bibliog.html
Good Life Club – Coaching
 Six-month outcome data for the Good Life Club

project: An outcomes study of diabetes self-
management
 positive changes in four of eight self rated
symptom measures
 reductions in the reported use of GPs,
 improvements in social functioning
 large increases in all six confidence in self-
management items.
Colette J Browning & Shane A Thomas. Australian Journal of Primary Health —

Vol. 9, Nos. 2 & 3, 2003 www.goodlifeclub.info/
Peer led self management
http://www.latrobe.edu.au/aipc/director/plsmci/about_healthprof.htm
Key components of self management
 Based on patient perceived

problems
 Builds confidence (self-
efficacy) to perform 3 tasks
 Disease Management
 Role Management
 Emotional Management
 Focus on improved health
status and appropriate
health care utilization
Kate Lorig DPMI Workforce Development – The Alfred Workforce Development Team June 2005
How self management differs from
patient education
Self-Management Patient
Education
Self-Management Patient
Purpose To manage life Education To change
Purpose: with
To Manage Life disease
To Change behaviors
With Disease Behaviors
To Increase Skills/Self- To Increase
To increase skills To increase

Confidence Knowledge
To Problem Solve To Use Specific
/self confidence
And Make DecisionsTools knowledge
Kate Lorig
To problem solve To use specific

and make decisions tools
Kate Lorig
How self management differs
from patient education
Self Patient
Management Education
Needs Patient What patients
Assessment problems need to know
Content Disease, role, Disease

& emotional knowledge and
management behaviors
Leader Leader is guide Leader is expert
Kate Lorig
Essential elements of self management
interventions
 Disease, medication and health management
 Role management
 Emotional management
 Support enhancement of self efficacy
 Problem solving training
 Follow up
 Tracking and ensuring implementation
The Robert Wood Johnson Foundation.The Centre for the Advancement of
Health. www.cfah.org
Handling self management tasks
S/M Task Passive Active
Medical Deferred Collaborates
Management
Role Relinquishes Strives to

Management maintain
Emotional Erratic Regular use of

Management ineffectual coping skills
A. Jerant et al. “Patients perceived barriers to active self-management of chronic

disease” Patient education and counseling. 57,3 June 2005
Handling self management tasks
S/M skills Passive Active
Problem Catastrophists Systematic
Solving process
Decision making Made in haste Carefully weighs

fear options
Resource Erratic Regular use of

Utilisation ineffectual coping skills
Partnership Minimal Identifies and selects

with HPs HPs for support
Action Planning Minimal Applied frequently
Self Tailoring Minimal Frequent
Promoting self efficacy
 Promote performance accomplishment

 Use verbal persuasion
 Role modelling
 Identifying feelings and helping work
through strategies to deal with feelings
Goal Setting- Getting started
 Choose long term goal

 Goals should be something you want to do
Identify steps needed to reach long term

goal
Choose one of those steps to start

working towards goal
SMART
 Specific
 Measurable
 Achievable
 Realistic
 Timely
Flinders University
Guidelines for helping with - Problem
solving
 Identify the problem

 List ideas
 Select one
 Assess the results
 Substitute another idea (if first didn’t
work)
 Accept that the problem may not be
solvable
Kate Lorig

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Module 4.

Produced by The Alfred Workforce Development Team

 Service providers and project workers on DPMI projects

 To encourage consumers to self manage

 Self-management is the active participation by

National Chronic Disease Strategy (Draft) National Health Priority

 Evidence to support self

 Decreases health care

 Barlow J. et a “Self – management

Ann Nosworthy April 2004 ADEA. www.adea.org.au

Asra Warsi,et al. Arch Intern Med. 2004;164:1641-1649

 Improvements in utilisation and costs

 Six-month outcome data for the Good Life Club

Colette J Browning & Shane A Thomas. Australian Journal of Primary Health —

 Based on patient perceived

To increase skills To increase

To problem solve To use specific

Content Disease, role, Disease

Leader Leader is guide Leader is expert

Role Relinquishes Strives to

Emotional Erratic Regular use of

A. Jerant et al. “Patients perceived barriers to active self-management of chronic

Decision making Made in haste Carefully weighs

Resource Erratic Regular use of

Partnership Minimal Identifies and selects

Action Planning Minimal Applied frequently

Self Tailoring Minimal Frequent

 Promote performance accomplishment

 Choose long term goal

Identify steps needed to reach long term

Choose one of those steps to start

 Identify the problem

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