An exploration of interventions for supported self-management and behaviour change delivered as routine clinical care for people living with long-term health conditions.

McCallum, Mary

Abstract

With our ageing, increasingly overweight and sedentary population, the National Health Service faces many challenges, not least the unprecedented rise in chronic long-term conditions. The first-line treatment for such conditions is lifestyle change, including weight loss, smoking cessation and increasing physical activity. Current NHS policy emphasises that people should be supported to self-manage and yet there is sparse information available about how to achieve this in everyday clinical practice. My thesis by public output provides original insights by contributing to a gap in the literature, detailing the specific components of interventions I have found effective to support self-management when delivered as part of routine care, and identifying what is valued by participants and health care professionals. This thesis includes five of my published and co-authored papers, which provide descriptions of interventions for people living with diabetes, obesity, peripheral arterial disease and non-alcoholic fatty liver disease. It also refers to a further nine papers I have published in the field of supported self-management and behaviour change, which have influenced the construction of this thesis (Appendix 1). My research question was "what are the specific components of successful psychological interventions delivered in routine clinical practice to support self-management for people with long-term health conditions in secondary care contexts". This thesis contributes to an evidence-based rationale for how to deliver supported self-management interventions as part of routine care. Key themes run through works (I-V) conducted in outpatient clinics in a hospital setting. They describe how lifestyle support was incorporated into everyday clinical practice using a multi-disciplinary approach, with input from health psychology, dietetic and nursing colleagues. They focus on effective process and intervention components highlighted by participants and clinicians. Effective process components included: good integration of the intervention with other aspects of routine care; ease of referral; expertise of the psychologist delivering the intervention; and flexible follow-up depending on patient preference. Effective intervention components included: a theory-informed, collaborative person-centred approach; the use of motivational interviewing skills to support participants to develop a tailored plan; specific behaviour change techniques (from the behaviour change technique taxonomy v1); provision of quality resources to facilitate lifestyle change, including self-monitoring tools; and linking in with third-sector. These components are summarised in a guiding template, and mapped onto theoretical constructs and specific behaviour change techniques. The ethos of my approach was person-centred. This thesis is relevant for health care policy and practice in that it has demonstrated promising results for participants who engaged in the supported self-management (SSM) interventions across works (I-V), with statistically significant improvements in clinical markers (such as blood glucose readings) and mood, quality of life and physical activity. Recommendations for future research are made, including the need for longer-term follow up; a holistic approach to evaluation beyond the narrow focus on biomedical markers and conventional clinical outcomes, and the need for organisational buy-in to allow training and time for Health Care Professionals to effectively implement supported self-management in routine care. This thesis provides a clearer picture about what works to support people to better self-manage within a routine health care consultation.

Citation

MCCALLUM, M. 2023. An exploration of interventions for supported self-management and behaviour change delivered as routine clinical care for people living with long-term health conditions. Robert Gordon University, PhD by Public Output thesis. Hosted on OpenAIR [online]. Available from: https://doi.org/10.48526/rgu-wt-2271565

• Thesis Type: Thesis by Publication
• Deposit Date: Mar 14, 2024
• Publicly Available Date: Mar 14, 2024
• DOI: https://doi.org/10.48526/rgu-wt-2271565
• Keywords: Long-term health conditions; Patient self-management; Behaviour change
• Public URL: https://rgu-repository.worktribe.com/output/2271565
• Additional Information: The file accompanying this record consists of the document that was produced to contextualise the public outputs (which form the main body of the thesis). Citations for the public outputs in question are located near the beginning of the document.
• Award Date: Sep 30, 2023