Background and aim
Self-management support is an integral part of current chronic care guidelines. The success
of self-management interventions varies between individual patients, suggesting a need for
tailored self-management support. Understanding the role of patient factors in the current
decision making of health professionals can support future tailoring of self-management
interventions. The aim of this study is to identify the relative importance of patient factors in
health professionals’ decision making regarding self-management support.
Method
A factorial survey was presented to primary care physicians and nurses. The survey consisted
of clinical vignettes (case descriptions), in which 11 patient factors were systematically
varied. Each care provider received a set of 12 vignettes. For each vignette, they
decided whether they would give this patient self-management support and whether they
expected this support to be successful. The associations between respondent decisions
and patient factors were explored using ordered logit regression.
Results
The survey was completed by 60 general practitioners and 80 nurses. Self-management
support was unlikely to be provided in a third of the vignettes. The most important patient
factor in the decision to provide self-management support as well as in the expectation that
self-management support would be successful was motivation, followed by patient-provider
relationship and illness perception. Other factors, such as depression or anxiety, education
level, self-efficacy and social support, had a small impact on decisions. Disease, disease
severity, knowledge of disease, and age were relatively unimportant factors.
Conclusion
This is the first study to explore the relative importance of patient factors in decision making
and the expectations regarding the provision of self-management support to chronic disease
patients. By far, the most important factor considered was patient’s motivation; unmotivated
patients were less likely to receive self-management support. Future tailored interventions
should incorporate strategies to enhance motivation in unmotivated patients. Furthermore,
care providers should be better equipped to promote motivational change in their patients.