What helps clinicians embed self-management into routine practice? A rapid realist review

Self-management support is designed to assist people living with chronic health conditions manage their condition, however health professionals struggle to integrate these principles into practice.  We aim to find which strategies to embed these principles into practice work for which type of clinician under what conditions.

Self-management programmes to assist patients develop skills to manage chronic health conditions have seen a wide clinical uptake despite varied and generally modest outcomes for patients. Integrating self-management techniques into routine health service delivery may result in better and more sustained outcomes through greater access and provision of ongoing support for patients. However, our recent metasynthesis¹ highlights clinicians find delivering self-management in practice to be complex, limiting uptake into routine practice.

The aim of realist review methodology is to critically examine what works, for whom, and in what circumstances to inform the development of a programme theory to underpin intervention development.

Question: What strategies/interventions, contextual factors and mechanisms are necessary to develop capacity for clinicians to embed self-management techniques into routine practice?

Methods: We are undertaking a review of the literature in collaboration with a reference group (people with local knowledge) and an expert panel (people with content knowledge and understanding of international state of evidence), as is customary for this methodology. The reference group (comprising key stakeholders, including expert clinicians from district health boards and primary health organisations) and expert panel (international content experts) help to narrow the scope of the review and identify starting points for literature and snowballing techniques for searching.

Outcome: The synthesis will result in a programme theory to inform intervention development. This review will be submitted for publication. We plan to test the developed theory and intervention in a realist evaluation.

Further details

Publications

• Mudge, S., Kayes, N., & McPherson, K. (2015). Who is in control? Clinicians' view on their role in self-management approaches: a qualitative metasynthesis. BMJ Open, 5(5), e007413-e007413. doi:10.1136/bmjopen-2014-007413

Poster

• How clinicians view their role in self-management programmes: a metasynthesis