Training health professionals to support people with progressive neurological conditions to self-manage: A realist inquiry

Introduction Supporting patients to effectively self-manage their own conditions is known to be challenging for health professionals. It requires specific skills and often challenges existing practice. Supporting self-management among people with progressive neurological conditions may represent additional challenges due to the multiple evolving symptoms people with these conditions may experience. Methods Realist methods were used to investigate how training interventions that target health professionals working with people with progressive neurological conditions and aim to improve self-management support provision work, for whom and in what circumstances. Phase One (used for theory development) included a survey of 186 health professionals and a realist literature synthesis including 44 papers (supplemented by stakeholder advisory groups and five key informant interviews). Phase Two (used for theory refinement) involved the evaluation of a two-day training course in “Health Coaching Skills” delivered to twenty health professionals. Data were collected in Phase Two through observations of the training days, individual telephone interviews with participants and trainers (total = 33 interviews) and pre-and post-training questionnaires. Relevant formal theories informed the analysis. Results Four initial rough theories were developed in Phase One and subsequently refined in Phase Two. Context-mechanism-outcome configurations were generated during each stage and used to develop an overall programme theory. Key training mechanisms identified included critical reflection on current practice and the development of knowledge, skills and confidence. Training participants need to become convinced of the relevance of the training to their setting, a process which is influenced by their experiences of implementing the training. Conclusions Implementation patterns following training vary widely. Training tends to be most successful when participants build self-belief in the new skills, while also becoming convinced that patients will be responsive, and that their working patterns can accommodate a change in approach. Experiencing significant role conflict can inhibit change