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.
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Long-term conditions (LTC) are any ongoing, long-term or recurring conditions that can have a significant impact on people’s lives as defined in the National Health Committee Report, 2007.(1) Supporting people with LTCs to manage their conditions becomes more important as the population ages and people are increasingly managing more than one condition. Self-management support has been described by the Health Foundation as a portfolio of techniques and tools that help patients choose healthy behaviours; and as a fundamental transformation of the patient-caregiver relationship into a collaborative partnership (2).
Any self-management support must:
be appropriate for the person with the LTC and their family and whānau
be developed in partnership with the person with the LTC
focus on reducing inequities in health.
Much of the content on this page is from a paper published by the Ministry of Health in 2016 (3) as the result of three sector workshops in 2015 to share best practice and innovation for the primary and community health sectors. It includes definitions of key terms related to LTCs, as well as links to examples of current work in New Zealand. This paper was written as a background paper for funders, planners and practitioners in New Zealand.
Self-management in context
Some people take issue with the term ‘self-management’ because it could suggest a focus on the ‘self’ as an individual at the expense of important social contexts, particularly family and whānau. Self-management theory, however, takes a holistic view that gives priority to engaging with people with LTCs within their wider social context. This approach is in keeping with the views of Māori, Pacific and South Asian peoples, who emphasise interdependence rather than personal independence.
Self-management support has been identified as one of the 10 characteristics that contribute to a high-performing chronic care system by Ham and colleagues in 2010.(4) This section discusses and defines self-management and self-management support, along with multimorbidity, equity and self-management education as terms that are closely linked to these concepts. This background information sets the context for the next section, which focuses on self-management in practice.
Many long-term conditions are more common in older people. As more people live longer, New Zealand is likely to have more people with two or more LTCs (multimorbidity). In the 2012/13 New Zealand Health Survey, nearly one in four adults reported two or more LTCs. While fewer people reported three conditions (6.4 percent) and four or more conditions (3.7 percent), the true prevalence is likely to be higher across all categories because the survey covered only a limited number of conditions (Ministry of Health 2014, p 204).
Research has shown that some individuals with multimorbidities give more attention to managing a dominant illness and less attention to their other conditions. However, some studies have shown that multimorbidity improves patient self-management. Bratzke et al 2015 (5). For people with multimorbidity, a person-centred and integrated approach to supporting management is particularly important.
Equity is defined by the World Health Organization as the absence of avoidable or remediable differences among groups of people.
What is health equity?
The definition of health equity by the Ministry of Health is as follows:
“In Aotearoa New Zealand, people have differences in health that are not only avoidable but unfair and unjust. Equity recognises different people with different levels of advantage require different approaches and resources to get equitable health outcomes.”
The concept acknowledges that not only are differences in health status unfair and unjust, but they are also the result of differential access to the resources necessary for people to lead healthy lives.
What does this mean?
equality is treating people the same
equity is treating people fairly.
Equity is about being prepared to work differently to help people achieve the same outcomes.
In this illustration, the first picture shows what happens when everyone gets treated the same. In the second picture, we can see that each person gets the support they need to see the game. The third picture shows everyone being able to watch the game without additional supports because the systemic structures and biases that cause the inequity have been removed.
In this video, Susan Reid talks about addressing inequity in primary care using the treatment of gout as an example.
Associated guide for clinical teams using the ‘Addressing inequity in primary care’ video
This guide provides questions and suggestions for how this short video (9 minutes) can be used by practice teams, GP and nurse peer groups or PHO facilitators to stimulate discussion and action.
To find out more, see the following:
‘Self-management’ refers to any way in which a person with an LTC manages their condition by themselves. Learning and practising self-management is an ongoing process; it is not achieved in a single step. Self-management is a continuum of learning experiences and opportunities, where a person with an LTC and their family and whānau work in collaboration with carers and health professionals.
Self-management is about enabling people with LTCs to ‘make informed choices, to adopt new perspectives and generic skills that can be applied to new problems as they arise, to practice new health behaviours, and to maintain or regain emotional stability’ (Lorig 1993).
The seven Principles of Self-Management are an important part of the Flinders Program™ (Flinders Human Behaviour and Health Research Unit 2006). They identify a ‘good’ self-manager as someone who:
knows about their condition
follows a treatment plan (care plan) agreed with their health professionals
actively shares in decision-making with health professionals
monitors and manages signs and symptoms of their condition
manages the impact of the condition on their physical, emotional and social life
adopts lifestyles that promote health
has access to support services and has the confidence and ability to use them.
This video offers an introduction to the principles of self-management and how it can support people managing long term conditions.
Supporting self-management involves educating people about their condition and care and motivating them to care for themselves better. Self-management support can be viewed in two ways: as a portfolio of techniques and tools that help patients choose healthy behaviours; and as a fundamental transformation of the patient-caregiver relationship into a collaborative partnership (Health Foundation 2011). Through self-management support and good-quality clinical care, people get the full range of support they need to manage the physical, emotional and social impact of their LTCs at different ages and stages of their lives. (Health Foundation 2015).
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.
Principles of self-management support
Twelve evidence-based practices and processes identified by Battersby et al in 2010 that improve self-management support in primary care are:
brief targeted assessment
evidence-based information to guide shared decision-making
use of a non-judgemental approach
collaborative approach to setting priorities and goals
collaborative problem solving
self-management support by diverse providers
self-management interventions in diverse formats
guideline-based case management for selected patients
links to evidence-based community programmes
This video describes self-management support & how it helps with long term conditions.
‘Self-management education’ (SME) is a systematic intervention that teaches a person to actively participate in self-monitoring (of physiological processes) and/or decision-making (managing) relating to their condition/s. It recognises that, if an individual is to continue to self-manage their condition/s over the long term, they must be able to collaborate with their health care providers and use problem-solving skills.
SME provides people with LTCs with the knowledge, skills and motivation they need to make decisions. It also increases their capacity and confidence to apply these skills in daily life.
Providers of SME must tailor the content and skill-training components of SME to the individual patient. Factors to consider are the types of LTC and recommended therapy, the patient’s ability, potential barriers to self-management, the patient’s motivation for learning and change, the patient’s culture, the patient’s literacy level, and available resources.
In this video Kate Lorig presents some of the evidence for structured SME programmes.
Meeting the needs of people with chronic conditions, National Health Committee, 2007
Health Foundation. 2011. Helping people help themselves A review of the evidence considering whether it is worthwhile to support self management. London: Health Foundation.
Self-management support for people with long-term conditions Ministry of Health NZ, 2016
Ham, C. (2010). The ten characteristics of the high-performing chronic care system. Health Economics, Policy and Law, 5(1), 71-90. Abstract
Bratzke LC, Muehrer RH, Kehl KA, et al. 2015. Self-management priority setting and decision-making in adults with multimorbidity: a narrative review of literature. International Journal of Nursing Studies 52(3): 744–55.
Health Foundation. 2015. A Practical Guide to Self-management Support: Key components for successful implementation. London: Health Foundation.