There are various reasons why efforts to promote “support for self-management” have rarely delivered the kinds of sustainable improvements in healthcare experiences, health and wellbeing that policy leaders internationally have hoped for. This paper explains how the basis of failure is in some respects built into the ideas that underpin many of these efforts. When (the promotion of) support for self-management is narrowly oriented towards educating and motivating patients to adopt the behaviours recommended for disease control, it implicitly reflects and perpetuates limited and somewhat instrumental views of patients. It tends to: restrict the pursuit of respectful and enabling ‘partnership working’; run the risk of undermining patients’ self-evaluative attitudes (and then of failing to notice that as harmful); limit recognition of the supportive value of clinician-patient relationships; and obscure the practical and ethical tensions that clinicians face in the delivery of support for self-management. We suggest that a focus on enabling people to live (and die) well with their long-term conditions is a promising starting point for a more adequate conception of support for self-management. We then outline the theoretical advantages that a capabilities approach to thinking about living well can bring to the development of an account of support for self-management, explaining, for example, how it can accommodate the range of what matters to people (both generally and more specifically) for living well, help keep the importance of disease control in perspective, recognize social influences on people’s values, behaviours and wellbeing, and illuminate more of the rich potential and practical and ethical challenges of supporting self-management in practice.
Bibliographical noteThis research was funded by The Health Foundation (a charity working to improve the quality of healthcare in the UK) via (a) a commission on conceptualising collaborative care, (b) an Open Insight initiative project on re-conceptualising support for self-management (reference 7209), and (c) a contribution towards salary funding for Alan Cribb.
At the University of Aberdeen, Vikki Entwistle works within the Health Services Research Unit, which is core funded by the Chief Scientist Office of the Scottish Government’s Health and Social Care Directorates.
Health Foundation and Scottish Government staff are among those who have participated in knowledge exchange events related to the two projects. The views expressed in the paper are those of the authors and are not necessarily shared by funders or workshop participants. The authors accept full responsibility for this paper.
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- capabilities approach
- chronic conditions
- professional-patient relations
- patient participation
- quality of life
- person centred care