Exploring and quantifying preferences towards self-management support interventions: a mixed-methods survey among individuals with long term health conditions

 

Funder: Health Foundation

Amount: £155,800

Behavioural Science Centre Member: Dr. Seda Erdem (CI)

Other Researchers: Andrea Manca (PI; University of York), Yvonne Birks (CI; University of York), Peter Bower (CI; University of Manchester), Debra de Silva (Evidence Centre in London), Cynthia Iglesias (CI; University of York), Gerry Richardson (CI; University of York), Bernard van den Berg (CI; University of York).

Person-centred healthcare provision requires information not only about which strategies are effective and cost effective, but also for whom. This is because most healthcare interventions work for some individuals but not for others, a phenomenon which can be ascribed to two main factors: first, the type and nature of a health condition (e.g. whether chronic or acute, how it manifests itself and its impact on an individual's health); and second, differences between patients (e.g. in terms of baseline risk, treatment response, preferences, personality, attitudes and behaviours). It is the complex interaction between the characteristics of an individual and those of his/her condition(s) which make an important contribution the level of patient's engagement with the healthcare system, compliance and adherence with treatment, satisfaction, health outcomes and use of healthcare resources.  The current paradigm shift in UK health policy towards a more 'person-centred healthcare' attempts to address this issue by placing patients and the public in a position where they can have access to more information, and exert greater choice and control, in the form of shared decision making aimed at providing interventions to individuals' characteristics, needs and preferences.

The management of long term conditions  in primary care is one of the areas where a more person-centred healthcare provision may yield substantial financial and non-financial benefits to patients, their families and the National Health Service.  Long-term conditions now account for about 50% of all GP appointments, 64% of all outpatient appointments and over 70% of all inpatient bed days.  Around 70% of the total health and care spend in England (£7 out of every £10) is attributed to caring for people with long term conditions. A recent evidence review by Silva et al. (2011) found that supporting self-management , in particular through focused proactive strategies aimed at behaviour change and supporting self-efficacy in patients, can have a positive impact on people's clinical symptoms, attitudes, quality of life and patterns of healthcare resource use. 

There is a wide range of interventions designed to encourage and support self-management; knowledge in this area is developing, however evidence about the best strategies to support behaviour change is  limited at this stage. Effective provision of person-centred self-management strategies requires data understanding of (i) the aspects of self-management support (e.g. process, outcomes) that matter to patients, (ii) the value patients place on these features, and (iii) the trade-offs patients are prepared to make between characteristics of competing self-management support interventions. Our study focuses on gathering data and producing evidence in relation to each of these points using Discrete Choice Experiments.

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