There are various reasons why efforts to promote “support for self-management” have rarely delivered the kinds of sustainable improvements in healthcare experiences, health and wellbeing that policy leaders internationally have hoped for. This paper explains how the basis of failure is in some respects built into the ideas that underpin many of these efforts. When (the promotion of) support for self-management is narrowly oriented towards educating and motivating patients to adopt the behaviours recommended for disease control, it implicitly reflects and perpetuates limited and somewhat instrumental views of patients. It tends to: restrict the pursuit of respectful and enabling ‘partnership working’; run the risk of undermining patients’ self-evaluative attitudes (and then of failing to notice that as harmful); limit recognition of the supportive value of clinician-patient relationships; and obscure the practical and ethical tensions that clinicians face in the delivery of support for self-management. We suggest that a focus on enabling people to live (and die) well with their long-term conditions is a promising starting point for a more adequate conception of support for self-management. We then outline the theoretical advantages that a capabilities approach to thinking about living well can bring to the development of an account of support for self-management, explaining, for example, how it can accommodate the range of what matters to people (both generally and more specifically) for living well, help keep the importance of disease control in perspective, recognize social influences on people’s values, behaviours and wellbeing, and illuminate more of the rich potential and practical and ethical challenges of supporting self-management in practice.
Batalden, M., Batalden, P., Margolis, P., Seid, M., Armstrong, G., Opipari-Arrigan, L., et al. (2015). Co-production of healthcare service. BMJ Quality and Safety. doi: 10.1136/bmjqs-2015-004315.
Boyle, D., & Harris, M. (2009). The challenge of co-production. London: NESTA.
Busse, R., Blümel, M., Scheller-Kreinsen, D., & Zentner, A. (2010). Tackling chronic disease in Europe: Strategies, interventions, challenges. Copenhagen: World Health Organization for European Observatory on Health Policies and Systems. http://www.euro.who.int/data/assets/pdf_file/0008/96632/E93736.pdf. Accessed 23 Feb 2016.
Carel, H. (2008). Illness: The art of living. London: Routledge.
Davis, J. B. (2011). Individuals and identity in economics. New York: Cambridge University Press.
Department of Health. (2005). Self-care—A real choice. London: Department of Health.
Dunston, R., Lee, A., Boud, D., Brodie, P., & Chiarella, M. (2009). Co-production and health system reform—from re-imagining to re-making. Australian Journal of Public Administration,68(1), 39–52. CrossRef
Entwistle, V. A., & Cribb, A. (2013). Enabling people to live well: Fresh thinking about collaborative approaches to care for people with long term conditions. London: The Health Foundation.
Hughes, J. L. (2009). Chronic fatigue syndrome and occupational disruption in primary care: Is there a role for occupational therapy? British Journal of Occupational Therapy,72, 2–10. CrossRef
Institute of Medicine. (2003). Priority areas for national action: Transforming health care quality. Washington, DC: National Academies Press.
Kennedy, A., Rogers, A., Chew-Graham, C., Blakeman, T., Bowen, R., Gardner, C., et al. (2014). 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. Implementation Science,9, 129. CrossRefPubMedPubMedCentral
Klein, S., & McCarthy, D. (2010). Genesys healthworks: Pursuing the triple aim through a primary care- based delivery system, integrated self- management support, and community partnerships. New York: The Commonwealth Fund. http://www.commonwealthfund.org/publications/case-studies/2010/jul/genesys-healthworks. Accessed 13 Feb 2016
Kroon, F. P. B., van der Burg, L. R. A., Buchbinder, R., Osborne, R. H., Johnston, R. V., & Pitt, V. (2014). Self-management education programmes for osteoarthritis. Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.CD008963.pub2.
Lindemann-Nelson, H. (2001). Damaged identities: Narrative repair. New York: Cornell University.
Long Term Conditions Alliance for Scotland. (2008). Gaun yersel: The self-management strategy for long-term conditions in Scotland. Edinburgh: The Scottish Government.
Lorig, K., Holman, H., Sobel, D., Laurent, D., Gonzalez, V., & Minor, M. (2006). Living a healthy life with chronic conditions (3rd ed.). Palo Alto: Bull Publishing.
Mackenzie, C. (2014). The importance of relational autonomy and capabilities for an ethics of vulnerability. In C. Mackenzie, W. Rogers, & S. Dodds (Eds.), Vulnerability: New essays in ethics and feminist philosophy (pp. 33–59). New York: Oxford University Press.
McLeod, C. (2002). Self trust and reproductive autonomy. Cambridge: MIT Press.
Mol, A. (2008). The logic of care: Health and the problem of patient choice. London: Routledge.
Morgan, H. M., Entwistle, V. A., Cribb, A., Christmas, S., Owens, J., Skea, Z. C., et al. (2016). We need to talk about purpose”: A critical interpretive synthesis of health and social care professionals’ approaches to self-management support for people with long-term conditions. Health Expectations. doi: 10.1111/hex.12453. PubMedPubMedCentral
Nussbaum, Martha C. (2011). Creating capabilities. Cambridge: Belknap Press. CrossRef
Owens, J., & Cribb, A. (2013). Beyond choice and individualism: Understanding autonomy for public health ethics. Public Health Ethics,6(3), 262–271. CrossRef
Pearson, M. L., Mattke, S., Shaw, R., Ridgely, M. S., Wiseman, S. H. (2007). Patient self- management support programs: An evaluation. AHRQ Publication No. 08-0011 http://www.ahrq.gov/sites/default/files/publications/files/ptmgmt.pdf. Accessed 23 Feb 2016.
Robeyns, I. (2011) The capability approach. In E. N. Zalta (Ed.) The stanford encyclopedia of philosophy (Summer 2011 Edition).http://plato.stanford.edu/archives/sum2011/entries/capability-approach.
Robeyns, I. (2016). Capabilitarianism. Journal of Human Development and Capabilities. doi: 10.1080/19452829.2016.1145631.
Scottish Government. (2010) The quality strategy for NHS Scotland. Edinburgh. http://www.gov.scot/Resource/Doc/311667/0098354.pdf. Accessed 23 Feb 2016.
Sen, A. (1999). Development as freedom. New York: Oxford University Press.
Sen, A. (2009). The idea of justice. Cambridge: The Belknap Press.
Smith, M. L., & Seward, C. (2009). The relational autonomy of Amartya Sen’s capability approach. Journal of Human Development and Capabilities,10(2), 213–235. CrossRef
Snow, R., Humphrey, C., & Sandall, J. (2013). What happens when patients know more than their doctors? Experiences of health interactions after diabetes patient education: A qualitative patient-led study. BMJ Open. doi: 10.1136/bmjopen-2013-003583.
Taylor, S. J. C., Pinnock, H., Epiphaniou, E., Pearce, G., Parke, H. L., Schwappach, A. et al. (2014). A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS—Practical systematic review of self-management support for long-term conditions. Health Services and Delivery Research. 2(53). ISSN 2050-4349.
Venkatapuram, S. (2011). Health justice: An argument from the capabilities approach. London: Polity Press.
Wagner, E. (1998). Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice,1(1), 2–4. PubMed
Wanless, D. (2002). Securing our future health: Taking a long term view. London: HMSO.
Wolff, J., & De-Shalit, A. (2007). Disadvantage. Oxford: Oxford University Press. CrossRef
World Health Organization. (2013). Global action plan for the prevention and control of non-communicable diseases 2013–2020. Geneva: World Health Organization.
- Why Health and Social Care Support for People with Long-Term Conditions Should be Oriented Towards Enabling Them to Live Well
Vikki A. Entwistle
- Springer US