Abstract
BackgroundIn a research context, self-management solutions, which may range from simple book diaries to complex telehealth packages, designed to facilitate patients in managing their long-term conditions, have often shown cost-effectiveness, but their implementation in practice has frequently been challenging.MethodsWe conducted an interpretive qualitative synthesis of relevant articles identified through systematic searches of bibliographic databases in July 2014. We searched PubMed (Medline/NLM), Web of Science, LISTA (EBSCO), CINAHL, Embase and PsycINFO. Coding and analysis was inductive, using the framework method to code and to categorise themes. We took a sensemaking approach to the interpretation of findings.ResultsFifty-eight articles were selected for synthesis. Results showed that during adoption, factors identified as facilitators by some were experienced as barriers by others, and facilitators could change to barriers for the same adopter, depending on how adopters rationalise the solutions within their context when making decisions about (retaining) adoption. Sometimes, when adopters saw and experienced benefits of a solution, they continued using the solution but changed their minds when they could no longer see the benefits. Thus, adopters placed a positive value on the solution if they could constructively rationalise it (which increased adoption) and attached a negative rationale (decreasing adoption) if the solution did not meet their expectations. Key factors that influenced the way adopters rationalised the solutions consisted of costs and the added value of the solution to them and moral, social, motivational and cultural factors.ConclusionsConsidering ‘barriers’ and ‘facilitators’ for implementation may be too simplistic. Implementers could instead iteratively re-evaluate how potential facilitators and barriers are being experienced by adopters throughout the implementation process, to help adopters to retain constructive evaluations of the solution. Implementers need to pay attention to factors including (a) cost: how much resource will the intervention cost the patient or professional; (b) moral: to what extent will people adhere because they want to be ‘good’ patients and professionals; (c) social: the expectations of patients and professionals regarding the interactive support they will receive; (d) motivational: motivations to engage with the intervention and (e) cultural: how patients and professionals learn and integrate new skills into their daily routines, practices and cultures.
Highlights
Self-management (SM) of chronic disease, where patients manage their illness independently but with the support of health care professionals, has been shown to be cost-effective in a range of conditions [1,2,3]
This involved a systematic search for relevant publications, developing an initial coding framework based on the study aim, using an inductive approach to coding, whereby we developed new codes and categories in the framework as new factors were identified, interpreting the codes and categories for translation into themes, which were synthesised to aggregate findings, applying a sensemaking lens to further probe findings and to identify contexts within which SM solutions worked or did not
Managers implementing solutions are guided by a protocol of generalisable factors which may include a list of barriers and facilitators; as we have shown, these are contingent and changeable and can increase or decrease adoption
Summary
Self-management (SM) of chronic disease, where patients manage their illness independently but with the support of health care professionals, has been shown to be cost-effective in a range of conditions [1,2,3]. Self-management studies have sought to understand the reasons for implementation challenges from perspectives such as those of patients, professionals or health systems along with disease specific issues [11,12,13,14]. Comprehensive literature reviews and original studies on implementation in the wider healthcare literature have sought to understand factors that contribute to successful implementation [15,16,17,18,19]. Self-management solutions, which may range from simple book diaries to complex telehealth packages, designed to facilitate patients in managing their long-term conditions, have often shown cost-effectiveness, but their implementation in practice has frequently been challenging
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