Background
Method
Study setting
The development of a specific self-management support programme
Programme development | |||
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Time | Activity | Objective | Participants |
Mar. 09 | Initial workshop | Baseline introduction to the project. Discussions on a preliminary programme draft. | Regional representatives (N = 24); |
user representatives (n = 4) | |||
hospital units representatives (n = 8) | |||
primary health care representatives (n = 12) | |||
Ad-hoc working groups | In-depth considerations on revision needs. | Primary health care professionals (N = 8) | |
Jun. 09 | Second workshop | Joint audit on the revised programme draft. Discuss and agree upon a final programme. | Regional representatives (N = 20); |
user representatives (n = 5) | |||
hospital units representatives (n = 5) | |||
primary health care representatives (n = 10) | |||
Aug. 09 | Local training sessions | Pre-training on-site. | Group leaders in four municipalities (N = 15) |
Sep. 09 | Programme application starts in four municipalities |
Physical exercise | Self-management education |
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0-8 weeks
| |
1-hour sessions, twice a week for 8 weeks. Led by local physiotherapists. | 2-hour sessions, once a week for 6 weeks. Led by local health professionals. |
Principles:
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Themes:
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1.Warm-up (15-20 min): exercises for large muscle groups. | 1. Establish the group. Assess expectations. Confidentiality. |
2. Work-out (30 min); strength, endurance, balance, mobility. | 2. Activity and social participation; recommendations and possibilities. |
3. Moderate intensity (12-15 on Borg RPE scale) with peaks of higher intensity. | 3. Chronic disease(s). Self-management, coping strategies, personal choices. |
4. Slow- down, stretching, relaxation (10-15 min). | 4. Family, friends, working situations. Chronic disease from relatives’ perspectives. |
5. Communication and cooperation. Interaction with health professionals. | |
6. How to move on. Personal goal- setting. Evaluation. | |
8 weeks -11 months
| |
No supervised exercise activities | 3- 4 telephone calls from a local health professional (1 every eight week). |
11-12 months
| |
1-hour sessions, once a week for four weeks. Led by local physiotherapists. | One 2 hours follow-up session; Up-date of previous themes, decisions on personal goals after completion at 12 months. Led by local health professionals. |
Recruitment procedures
Informants
Informants | Gender | Participated in a specific programme development | Living with a chronic disease or providing regular treatment | Total |
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User representatives | 4 males | 3 | 2 | 5 |
Primary health professionals | All females | 7 | 4 | 11 |
In total | 10 | 6 | 16 |
Data collection
Data analysis
Results
Acknowledgement of a generic and group-based approach
Many municipalities may have few individuals with a specific diagnosis. When health authorities develop self-management programmes (in primary health care) then it is important to meet the needs of most patients, and not just one particular group. (User informant)
It will reduce the workload. Groups are time saving. It is a lack of resources anyway. We reach more people working with groups (Health professional)This is not about waffles and coffee, but about the possibility to become a part of a fellowship. It has something to do with psychological aspects (User informant).
A special focus on everyday-life
What diagnosis they may have is not of major interest. If they have this or that diagnosis, they all have in common a reduction in their level of activity. This [programme] is an addition (User informant).
I do not expect health professionals to understand how it is to have a chronic disease. Still, they need to know something about psychological aspects, which concern all diagnoses. They may listen to the participants and try to imagine how difficult it is for anybody (User informant).A dedicated time for information and education, and another one to test it in practice, that provides for new learning and processes for the participants. (Health professional)
The importance of relevant professional competence
I wonder if small municipalities can manage to make this new service sustainable. They lack both the competence and the capacity (User informant).
This arrangement with communication in a group, it differs from other advice and instructions. This is a new way of working. It is a new focus and commitment towards the dialog and processes in the group (Health professional).
It is exciting to be part of something new. I think we just have to get started! Although I expect challenges ahead, gradually I will be more experienced (Health professional).