Providing self-management support (SMS) is a core component of delivering on the 2016 NZ Health Strategy where is it known as 'People-Powered'. This section provides an introduction to the benefits of effective self-management support and what this could look like in primary care.

What is "self-management"?

Self-management refers to the tasks that someone with a long-term condition (LTC) and their whānau or social network undertake to live well. It includes:

  • having and using the knowledge and improving understanding of the condition and/or its management

  • actively sharing in decision-making with health professionals, significant others and/or carers and other supporters

  • monitoring and managing signs and symptoms of the condition(s)

  • managing the impact of the condition on physical, emotional, occupational and social functioning

  • living healthier day to day by taking action to address risk factors and promote health by focusing on prevention and early intervention

  • adopting a self-management care plan agreed and negotiated in partnership with health professionals, significant others and/or carers and other supporters

  • having access to, and confidence in, the ability to use support services.

(Based on Flinders Human Behaviour & Health Research Unit: Principles of Self-Management)

What is "self-management support"?

Supported self-management means giving people with LTCs the assistance they need to increase the control they have over their own lives and health while minimising the constraints imposed on them by their health or disability. Self-management support (SMS) requires seeing patients not as passive recipients of care but as active partners (Bodenheimer et al 2005).


Characteristics of successful self-management support include:

  1. Assessment of self-management – learn what the client knows, their actions, strengths and barriers

  2. Collaborative problem definition – between client and health professionals

  3. Targeting, goal setting & planning – target the issues of greatest importance to the client, set realistic goals and develop a personalised care plan

  4. Self-management training and support services – include instruction on disease management, skills training, behavioural support, & address physical & emotional demands of having a long-term condition

  5. Active and sustained follow-up – reliable, planned, proactive follow-up leads to better outcomes


De Silva, D. (2011) Evidence: Helping people help themselves. The Health Foundation 2011

The benefits of self-management support are extensive and varied. Both the healthcare team and the patients in receipt of self-management support experience beneficial changes. For patients, families and those working in primary care, SMS looks more like this (see example)

Self-management support is underpinned by three core principles: health literacy, cultural competence, and person-centred care.