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Self-management support

Key points about self-management support

Self-management support is the help given to people with long-term conditions to enable you to manage your health on a day-to-day basis.
It includes regular assessment by your healthcare provider of your problems and progress.
At those sessions, you set goals and learn problem-solving approaches.
You also learn practical skills so you can better manage your long-term condition/s.
More self-management support improves your health outcomes and makes it less likely you will end up in hospital.

Larger woman chopping vegetables in kitchen

Self-management support is defined as the education initiatives and support given by healthcare providers and staff to enable anyone with a long-term condition to increase their skills and confidence in managing their health problems.

Self-management support requires changes in the health system and by healthcare providers to help you and your family/whānau to take care of yourself and manage your long-term condition more successfully.

(Know Your Own Health, UK, 2011)

Increased self-management support improves:

adherence to medication and treatment regimes
decision-making
communication
coordination
satisfaction with the service the person is receiving
health outcomes
quality of life.

Self-management support reduces:

hospitalisations
health disparities.

(CCMI, Canada, 2015)

Traditional patient education has been found relatively ineffective at changing behaviour. In contrast, self-management education is much more effective as it teaches individuals and their families/whanāu practical and generic skills that help them manage their health conditions.

Further, these skills tend to also improve their emotional, social and financial functioning, not only within their families but also their communities. Practically this results in improved health, wellbeing and ability to work as well as reduced family stress.

Stanford Model - Living a Healthier Life

This is a community-based programme generally held for 2.5 hours once a week for 6 weeks. The programme is used in over 22 countries around the world. There are a number of studies showing it is effective in helping people with a wide range of long-term conditions manage their health more effectively.

A number of organisations in New Zealand run self-management programmes based on this model, including Counties Manukau DHB and local primary health organisations such as ProCare Health, as well as Arthritis NZ (throughout the country).

Flinders Programme

This is a training programme and structured set of tools for healthcare providers to use when working one on one with clients and their families.

The tools facilitate assessment of a person's self-management capacity (what are the barriers and enablers) and what they see as their main problem or issue. The tools then help the healthcare provider and person together agree on the main issues, goals and interventions, resulting in an agreed care plan.

Again, this is an evidence-based approach that has proven very useful for working more collaboratively with clients and their families. For more information about the evidence-base and programme, visit the Flinders Program website(external link).

Whānau Pakari - Taranaki’s intervention programme for children with weight issues

Whānau Pakari is a family-based healthy lifestyle programme that supports children and adolescents (aged 4-16) who are struggling with weight issues in the Taranaki region. It means healthy, self-assured whānau/families in every sense of the word.

The programme is run by a multidisciplinary team comprised of a HLC, paediatrician, dietitian, physical activity advisor and a psychologist. It offers a home-based medical assessment and weekly activity session in the same programme.

The programme has evolved to offer a suite of age-appropriate interventions and different levels of support, decided on through initial consultation with the whānau and their needs. For more information about the programme, visit the website(external link).

Personal stories to watch

Expert patient programme

The Expert patient programme in the UK is based on the same Stanford self-management programme.

(NHS Local, UK, 2011)

Self management - Counties Manukau Health - ‘Kia kaha - manage better, feel stronger’

(Counties Manukau Health, NZ, 2015)

Personal stories to read

If there was one word to describe Liv Robinson, it would be “survivor”. The Wairarapa College old girl has had neurosurgery twice, pneumonia three times, and is blind. But those setbacks haven’t stopped her from making goals and striving to be the best version of herself she can be.

She and her mother Maggie say they have learned to take back their lives with the help of a free self-management course offered by Compass Health.

The courses are designed for people with long-term chronic health conditions like diabetes, heart condition, stroke, high blood pressure, arthritis, asthma, chronic pain, anxiety, depression, and weight concerns.

Maggie initially enrolled in the course in June to be Liv’s support person “because I care for her as my daytime job”, she says.

“But as the weeks went on, I realised I was actually learning quite a bit for myself.”

The Robinson family have been through a lot this past decade. Ten years ago, Liv, at the age of 20, was diagnosed with a rare brain tumour behind her eyes where her optic nerves crossed over. She had been studying geography and development at a university in Wellington at the time.

“Liv’s tumour was a rare tumour. One in 10 million we were told,” Maggie says.

“I tried for three years to get it diagnosed and suddenly, somebody took notice of me. I was being told I was an anxious mother. It was maddening. In that time the tumour had grown to the size of a walnut, and I wasn’t being taken seriously."

It was only by chance that Liv was seen by a young locum who requested a CAT scan and the tumour was discovered.

Liv undergoes brain surgery

From there, all the wheels were in motion and Liv was taken to Wellington Hospital where she had neurosurgery, accompanied by 25 doses of radiation over a span of a couple of months.

“The thing about Liv is she is such a rarity,” Maggie says.

“She has survived the odds, she’s had pneumonia three times, she had pneumonia and septicaemia at the same time in 2013 and I was told she was five minutes away from death at Wairarapa Hospital.

“They got the Westpac rescue helicopter in… and we landed on the roof of Wellington Hospital and she was taken to intensive care where she remained for 21 days."

In that time, we were praying and hoping she would respond.

“She was really sick. She was in this coma for about a week, and I knew she could hear me so I was talking about everything under the sun. It was an announcement on the radio of actor Russell Brand leaving singer Katy Perry that caused Liv to come out of her coma,” Maggie says.

The trauma did not end there for the mother and daughter team though. Maggie’s husband died suddenly last year after a stroke.

“After my husband died, Livy was hospitalised five times between September and February. It was probably the shock of grief in losing her dad. Having lost my husband, I was kind of floundering really. I was selling a house, building a new one, finding a place to rent which was very difficult. It was extremely stressful.”

Course helps pair through tough times

It was at this time that the pair began the self-management course with Compass Health.

Surprisingly, the pair say the course gave them “a lot of perspective on other people’s problems and what they are going through”.

“A problem shared is a problem halved,” Maggie says.

“For me, I’ve got a great support network around me, but I had never experienced grief before like I experienced. I have lost my parents, I’ve lost friends, but not my husband who was my partner for 42 years.”

Maggie says the course helped her deal with her grief, and encouraged her to set goals in order to “stay on track”.

For Liv, it is pushing her drive to find a job in the field of geography and development, though she said her disabilities are making prospective employment difficult.

“I’d like to do something environmental, not sure what, but something part-time,” she says.

“Making action plans is really useful to help strive. Making goals helps you to achieve something.”

To register your interest in Compass Health free self-management courses contact smcourse@compasshealth.org.nz.

What is self-management?(external link) A useful paper from the Flinders Human Behaviour and Health Research Unit (FHBHRU). It includes a discussion on the definition, a literature review covering information on self-management programmes, interventions, characteristics of effective programmes plus principles and concepts.
Self-management – a background paper(external link) Dr Patrick Gowan, University of Victoria, Center on Aging, Canada, written for the New Perspectives: International Conference on Patient Self Management held in Canada, 2005.
Bycroft JJ, Tracey J. Self-management support – a win-win solution for the 21st century(external link) NZ Family Physician. 2006;44(3):243-248.

For more information about self-management support, visit our dedicated Self-Management Support (SMS) Toolkit(external link) for healthcare providers.