Abstract
BackgroundA rising number of people with chronic conditions is offered interventions to enhance self-management. The responsiveness of individuals to these interventions depends on patient characteristics. We aimed to develop and validate a tool to facilitate personalised counselling and support for self-management in patients with chronic diseases in primary care.MethodsWe drafted a prototype of the tool for Self-Management Screening (SeMaS), comprising 27 questions that were mainly derived from validated questionnaires. To reach high content validity, we performed a literature review and held focus groups with patients and healthcare professionals as input for the tool. The characteristics self-efficacy, locus of control, depression, anxiety, coping, social support, and perceived burden of disease were incorporated into the tool. Three items were added to guide the type of support or intervention, being computer skills, functioning in groups, and willingness to perform self-monitoring. Subsequently, the construct and criterion validity of the tool were investigated in a sample of 204 chronic patients from two primary care practices. Patients filled in the SeMaS and a set of validated questionnaires for evaluation of SeMaS. The Patient Activation Measure (PAM-13), a generic instrument to measure patient health activation, was used to test the convergent construct validity.ResultsPatients had a mean age of 66.8 years and 46.6 % was female. 5.9 % did not experience any barrier to self-management, 28.9 % experienced one minor or major barrier, and 30.4 % two minor or major barriers. Compared to the criterion measures, the positive predictive value of the SeMaS characteristics ranged from 41.5 to 77.8 % and the negative predictive value ranged from 53.3 to 99.4 %. Crohnbach’s alpha for internal consistency ranged from 0.56 to 0.87, except for locus of control (α = 0.02). The regression model with PAM-13 as a dependent variable showed that the SeMaS explained 31.7 % (r2 = 0.317) of the variance in the PAM-13 score.ConclusionsSeMaS is a short validated tool that can signal potential barriers for self-management that need to be addressed in the dialogue with the patient. As such it can be used to facilitate personalised counselling and support to enhance self-management in patients with chronic conditions in primary care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0381-z) contains supplementary material, which is available to authorized users.
Highlights
A rising number of people with chronic conditions is offered interventions to enhance self-management
16.2 % had a diagnosis of diabetes mellitus, while 35.4 % of the female participants had this diagnosis
The International Classification of Primary Care (ICPC) codes for asthma/Chronic Obstructive Pulmonary Disease (COPD) were found in 12.0 % of the male participants, and 19.8 % of the female participants
Summary
A rising number of people with chronic conditions is offered interventions to enhance self-management. We aimed to develop and validate a tool to facilitate personalised counselling and support for self-management in patients with chronic diseases in primary care. The number of people suffering from one or more chronic conditions is rising rapidly. Substantial variation exists regarding the responsiveness of individuals to self-management interventions [7, 8]. One of the main reasons for the lack of success of self-management interventions is that they often fail to address the individual characteristics of the patient (i.e., personal barriers, needs and situation that play a role in selfmanagement behaviour), resulting in suboptimal reach and impact. The challenge is to find ways to enhance the impact of self-management programs by personalised counselling and support
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