Looking after yourself: Understandings of chronic-care self-management models in rural and urban contexts of UK and Australia

This paper reports on the outcomes of a two related projects undertaken during 2011-2012 in Australia (Rural Northern NSW) and the UK (Urban Northern UK) that sought to identify the strategies that clinicians employ to actively involve patients with chronic conditions in the planning and delivery of their care1,2,8. This study was informed by the global shift to partnership approaches in health policy and the growing imperative to deliver patient or client-centred care3,4,9,10. Support for self-management refers to the role that clinicians play in building client knowledge, skill and confidence to effectively manage their own healthcare concerns and treatments6. A qualitative methodology was used, with focus groups and interviews conducted to explore the strategies used by a range of primary healthcare providers, such as general practitioners, nurses, social workers, diabetes educators, dieticians and occupational therapists, to support clients to effectively manage their own chronic conditions. In particular this study aimed to understand the models and contexts of care that impacted on the participants’ practices and identify barriers and enablers to supporting client self-management from the participants’ perspective5,7. This paper presents the results of these studies and identifies the similarities and differences between the two contexts that have either facilitated or blocked clinicians’ efforts to support their clients to adopt self-care strategies7. We are not claiming national commentaries but are drawing on two studies that we consider provide insight into ‘typical’ practices in both countries. The finding of both studies identified that supporting patients/clients to engage in actively managing their health care needs requires changes to client and clinicians traditional perspectives on their role, practice and education, as well as developing more integrated health policies to better support clients with complex health care needs, who want to adopt self-management practices