Understanding beneficial self-management support and the meaning of user involvement in lifestyle interventions: a qualitative study from the perspective of healthcare professionals

Abstract

Background: In light of the high prevalence of overweight and obesity among adults and the subsequent stigmatization and health consequences, there is a need to develop effective interventions to support lifestyle change. The literature supports the key role of healthcare professionals (HPs) in facilitating self-management through lifestyle interventions for those with chronic conditions. However, there is a lack of knowledge about how HPs practice self-management support (SMS) and user involvement for persons afflicted by overweight or obesity in lifestyle interventions in primary care Healthy Life Centres (HLC). The aim of this study was to explore how HPs provide SMS and what user involvement implies for HPs in HLCs. Methods: An interpretative exploratory design, using qualitative thematic analysis of data from two focus group interviews with ten HPs from eight different HLCs, was conducted. Results: The analysis resulted in one overall theme; A partnership based on ethical awareness, non-judgemental attitude, dialogue and shared responsibility, comprising four interrelated themes: 1) Supporting self-efficacy, selfworth and dignity through an attitude of respect, acknowledgement and generosity, 2) Promoting self-belief and self-perceived health, 3) Collaborating and sharing responsibility, and 4) Being flexible, adjusting and sharing time. Conclusion: HPs in HLCs see service users as equal partners in a collaboration based on shared responsibility, acknowledgement and generosity. In order to help, their practice involves a heightened level of ethical awareness, including a non-judgemental attitude and dialogue. HPs in HLCs have something to teach us about ethical acting and helping persons who are struggling with overweight or obesity to change their lifestyle and regain dignity. They seem to see the service users' existential needs and have learned the art of meeting the other in her/his most vulnerable situation i.e., seeking help for a "wrong lifestyle". It may be time to highlight the need for SMS and user involvement to focus on shared responsibility in partnership rather than personal responsibility. More research is required to explore the conditions for such practice.

A qualitative study of self‐management experiences in people with non‐alcoholic fatty liver disease

“…The important aspects of self‐management in people with long‐term diseases include control, empowerment and confidence (Hoffman, 2013 ). Displays of attentiveness and genuine interest from HCPs are known to be essential to supporting patients’ self‐management and empowering them (Salemonsen et al., 2020 ). Empowerment is a particularly statistically significant issue in the context of people with NAFLD for several reasons.…”

“…HCPs’ being attentive involves not only monitoring liver function parameters but also closely assessing self‐management behaviours with a validated tool during each follow‐up visit and providing concrete feedback about health behaviours. This will serve to motivate patients to sustain advisable self‐management behaviours in living with NAFLD, which will, in turn, increase their self‐efficacy (Hoffman, 2013 ; Nicolai et al., 2018 ; Salemonsen et al., 2020 ). Thus, HCPs can enhance patients’ implementation and maintenance of optimal health behaviours by closely assessing and providing feedback on self‐management behaviours.…”

Beneficial self‐management support and user involvement in Healthy Life Centres—A qualitative interview study in persons afflicted by overweight or obesity

“…This is consistent with other studies of lifestyle interventions, showing that acknowledgement, equality and individualization are core elements of user involvement. 32,51,52 Thus, the importance of trained HPs who possess effective communication skills, and are competent, confident and supportive was highlighted. 32,49,53 In our study, HPs' flexibility and ability to personalize and tailor self-management support and lifestyle intervention to the service users' needs and everyday life was important for their participation and adherence to the intervention programme.…”

Self-management Support in Primary Care Practice: the Development of a Conceptual Model Using a Qualitative Approach

“…They have the opportunity to encourage patients to take part in their own care process. As a result, patients feel empowered and can actively be involved in their health care (23)(24)(25).…”

“…Since patients act as equal partners in a collaboration on shared responsibility (34), the importance of involving them in research cannot be underestimated. More insights are required to explore patients' experiences towards this partnership to selfmanage a chronic condition (25). Therefore, there is a need to investigate not only the underlying mechanisms that help people to self-manage a chronic condition, but also to listen to the voice of the patients themselves.…”