This review supports broadening the scope of group-based programmes to foreground shared learning, social support and development of agency. It is of relevance to developers and facilitators of group self-management programmes and their ability to address the burden of long-term conditions.

Isolated fetal islets show an immature or poor secretory response to nutrient secretagogues which may result from impaired mitochondrial oxidative processes. Insulin secretion, glucose metabolism and detection of metabolic enzymes by radiolabelling and immunoprecipitation were compared in islets isolated from neonatal (aged 5 days) and fetal rats (at 20 days gestation). The insulin secretory dynamics of fetal islets were abnormal in response to stimulation by glucose (10 mmol/l); a rapid release of insulin reaching a maximum 6 min after stimulation was observed with no rising second phase release. However, when the data were expressed as percentage of islet insulin content released, fetal islets released significantly more insulin than neonatal islets in response to glucose (4.86 +/- 0.45% vs 1.81 +/- 0.62%, p < 0.01) or 100 nmol/l glibenclamide (2.49 +/- 0.17% vs 0.25 +/- 0.06%, p < 0.001). Fetal islets however, failed to release insulin in response to stimulation by glyceraldehyde (10 mmol/l) unlike neonatal islets. Both glucose utilisation (as measured by the formation of [3H] H2O from 5-[3H] glucose) and glucose oxidation (as measured by the formation of [14C] CO2 from U-[14C] glucose) did not increase significantly in response to increasing the medium glucose concentration to 10 mmol/l whereas in neonatal islets, glucose utilisation and glucose oxidation were significantly increased 2.5- and 2.7-fold, respectively. When islets were incubated with both radiolabelled glucoses simultaneously, the rate of glucose oxidation was shown to be directly proportional to the rate of glucose utilisation. The relationship between glucose utilisation and glucose oxidation was similar in fetal and neonatal islets.(ABSTRACT TRUNCATED AT 250 WORDS)

Objective: To examine group facilitators' and participants' experiences of and engagement with goal setting in long-term condition (LTC) self-management group programmes. Design: We conducted a qualitative mixed method study including 13 interviews with group facilitators, 20 interviews with group participants and content analysis of programme workbooks. Participant interviews explored their goals for managing their condition. Facilitator interviews explored their goals for participants. Data from the three sources were analysed inductively and thematically. Results: The three themes showed: 1. Participants have personal and meaningful biomedical, social and emotional goals and, facilitators believe these goals to be important and perceive them as integral to increasing motivation and self-responsibility; 2. Facilitators shape participants' goals into predetermined health behaviour change activities, disregarding social and emotional aspects; and 3. Participant disengagement from the goal setting process and questioning of the value of goal setting was evident. Conclusions: Patient engagement with goal setting may be less attainable when what matters to people is sidelined to focus on behaviour change goals and self-responsibility. Yet, supporting people to identify and pursue meaningful goals for living with LTCs is more likely to increase engagement and motivation. Stakeholders in group programme development and delivery should review their goal setting activities.

Objectives Increasing self-management skills in people with long-term conditions is widely advocated in policies and guidelines. Group programmes are a common format; yet, how self-management support objectives are enacted in their delivery is poorly understood. Our aim is to explore the perspectives of group programme facilitators. Methods We undertook thematic analysis of transcribed data from in-depth semi-structured interviews with health professional facilitators (n = 13) from six diverse self-management support group programmes (of obesity, diabetes and chronic obstructive pulmonary disease). Results Facilitators viewed group programmes as responses to health system pressures, e.g. high patient demand. They focussed on providing in-depth education and instruction on physical health, risks and lifestyle behaviour change and emphasised self-responsibility for behaviour change whilst minimising goal setting and support amongst group participants. There were tensions between facilitators' professional identity and group leader role. Discussion Group self-management support programmes may not be realising the broader aspirations advocated in long-term condition policy to support medical, emotional and social aspects of long-term conditions by minimising shared learning, problem solving, building of self-efficacy and goal setting. This suggests a disconnect at implementation. Increasing understandings of theoretical and practical self-management support in group programmes across both implementation and health professional (HCP) training will further the professional skills in this format.