How do facilitators of group programmes for long-term conditions conceptualise self-management support?

Abstract

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.

Participants’ experiences of and perceived value regarding different support types for long-term condition self-management programmes

“…Thoits suggests support from similar others directly affects physical and mental health and indirectly buffers harmful physical and mental effects (27). However, research has shown health professional facilitators do not always prioritise this form of support and professional authority, evidence-based education and narrow biomedical conceptualisations of self-management support prevail (24,25,35). Little group-specific training of health professional facilitators has been found in the literature (23).…”

“…The group programmes in our study were perceived by participants as prioritising health professional and medical authority over exploration and nurturing of support for mutual benefit among the group participants. The 'invisibility' of the support that participants perceived and valued highly from peers may pose difficulties for health professional facilitators in the programme frameworks and medical contexts they operate within, which frequently use measurable biomedical outcomes to define success (5,24). Practitioners facilitating group self-management support programmes should be aware of the limitations inherent in professional expertise revealed in this study to people seeking support with self-managing LTCs.…”

“…A recent systematic review (23) of the experiences of participants in self-management group programmes revealed the importance of social support, belonging, connectedness and shared learning with other group participants. However, research on the experiences of group facilitators of self-management support shows that their focus remains predominantly on providing evidencebased education and instruction for health behaviour change to participants, rather than on group member interactions and peer support (5,24,25).…”

‘We're all in the same boat’: A qualitative study on how groups work in a diabetes prevention and management programme

“…Similarly, studies of group-based chronic disease self-management programmes showed that groups helped enhance selfefficacy for using self-management and coping strategies by providing opportunities for sharing experiences, social comparisons, and support (Abraham & Gardner, 2009;Barlow, Bancroft, & Turner, 2005;Rogers, Gately, Kennedy, & Sanders, 2009). Yet, the potential benefits of group support may not always be maximized by group facilitators in such interventions (Borek et al, 2019;Hughes et al, 2018). Yet, the potential benefits of group support may not always be maximized by group facilitators in such interventions (Borek et al, 2019;Hughes et al, 2018).…”

“…Research has also shown that developing a shared social identity is important in promoting health and engagement with group interventions (Tarrant, Hagger, & Farrow, 2012;Tarrant et al, 2017). Yet, the potential benefits of group support may not always be maximized by group facilitators in such interventions (Borek et al, 2019;Hughes et al, 2018). Previous studies have explored participants' experiences of health interventions in general.…”