Aligning everyday life priorities with people’s self-management support networks: an exploration of the work and implementation of a needs-led telephone support system

BMC Health Services Research

Anne Rogers¹  Tom Blakeman²  Helen Brooks²  Ivaylo Vassilev¹  Robert Bowen²  Rebecca Morris²  Praksha Jariwala²  Anne Kennedy¹  Christian Blickem² 

[1] NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex Health Sciences, University of Southampton, Highfield Campus, 12 University Road, Southampton SO17 1BJ, UK;NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK

关键词: Asset-based community development;    Chronic kidney disease;    Social prescribing;    Social networks;    Inequalities;    Randomized controlled trial;    Normalization process theory;    Long-term conditions;    Self-management;    Vascular disease;   

Others  :  1130765
DOI  :  10.1186/1472-6963-14-262

 received in 2013-09-09, accepted in 2014-06-10,  发布年份 2014

【 摘 要 】

Background

Recent initiatives to target the personal, social and clinical needs of people with long-term health conditions have had limited impact within primary care. Evidence of the importance of social networks to support people with long-term conditions points to the need for self-management approaches which align personal circumstances with valued activities. The Patient-Led Assessment for Network Support (PLANS) intervention is a needs-led assessment for patients to prioritise their health and social needs and provide access to local community services and activities. Exploring the work and practices of patients and telephone workers are important for understanding and evaluating the workability and implementation of new interventions.

Methods

Qualitative methods (interviews, focus group, observations) were used to explore the experience of PLANS from the perspectives of participants and the telephone support workers who delivered it (as part of an RCT) and the reasons why the intervention worked or not. Normalisation Process Theory (NPT) was used as a sensitising tool to evaluate: the relevance of PLANS to patients (coherence); the processes of engagement (cognitive participation); the work done for PLANS to happen (collective action); the perceived benefits and costs of PLANS (reflexive monitoring). 20 patients in the intervention arm of a clinical trial were interviewed and their telephone support calls were recorded and a focus group with 3 telephone support workers was conducted.

Results

Analysis of the interviews, support calls and focus group identified three themes in relation to the delivery and experience of PLANS. These are: formulation of ‘health’ in the context of everyday life; trajectories and tippingpoints: disrupting everyday routines; precarious trust in networks. The relevance of these themes are considered using NPT constructs in terms of the work that is entailed in engaging with PLANS, taking action, and who is implicated this process.

Conclusions

PLANS gives scope to align long-term condition management to everyday life priorities and valued aspects of life. This approach can improve engagement with health-relevant practices by situating them within everyday contexts. This has potential to increase utilisation of local resources with potential cost-saving benefits for the NHS.

Trial registration

ISRCTN45433299.

【 授权许可】

   
2014 Blickem et al.; licensee BioMed Central Ltd.

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