People with long term conditions can better manage their own health with training to give them the knowledge, skills and confidence.
Training for people with long term health conditions is important to help them develop the knowledge, skills and confidence to manage their health and live well.
When healthcare is designed to support self-management, people with long-term health conditions, and their carers, play a more active role in managing their own health, which can mean making difficult lifestyle changes. To do this, they need the knowledge, skills and confidence to manage not only their condition(s) but the practical and emotional impact it has on their lives. Evidence shows that people with the knowledge, confidence and skills to manage their health enjoy life more, have less pain, have improved clinical outcomes and use healthcare services less.
What we know makes a difference
To live well with their condition(s), people need to understand and manage their health condition, cope with the practical and emotional impact of their health, and develop other skills like working in partnership with their health care professionals.
Some key generic skills that people need include problem solving, goal setting, pacing, relaxation techniques, sourcing information and preparing for appointments. There are also some skills that are specific to different conditions, like carb counting in diabetes and noticing the colour of sputum for people with COPD. Some conditions also require people to have technical skills, such as self-administering medication. Different people are likely to need each of these skills to a different extent at different times.
These skills all need to be underpinned by a knowledge base about their condition, and people need to develop the confidence to take control and act (sometimes called self-efficacy).
Types of support
Local areas should provide a range or combination of types of training that are appropriate to people’s needs and preferences, so people can choose what is best for them.
Different approaches include:
- Generic structured education courses: these focus on common experiences of people with any long-term health condition and carers, like working with healthcare professionals, coping with pain and managing fatigue. Examples include the Stanford Model, known as the Expert Patient Programme (EPP) and the Patient Skills Programme from The Health Foundation.
- Condition specific structured education courses: these cover specific skills and knowledge needed to manage different conditions. Examples include the DAFNE (Dose Adjusted For Normal Eating) or DESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed) courses for people with diabetes.
- Integrating self-management skills into rehabilitation programmes: cardiac and pulmonary rehabilitation programmes can include sessions on how to embed the key self-management skills such as goal-setting
- One to One Coaching and motivational interviewing: provided face to face, over the phone or via Skype, this uses reflective listening and motivational interviewing to support individuals with making changes through goal setting.
- Online courses: websites can offer specific programmes or forums, to help people understand their condition, access information or learn techniques like relaxation.
- Recovery Colleges: focussing on support for people with mental health conditions, these consist of a range of one off workshops and longer courses, covering understanding of specific mental health conditions, the recovery model, or general skills such as mindfulness.
- Self-directed books: local libraries have collections of self-help books as well as reading lists for people who would like their mood boosting, or are carers for people with dementia.
Whatever combination of support is provided locally, the training should be linked into you’re the local long term conditions strategy and local learning and development strategy to ensure it is relevant and sustainable.
Key aspects of effective training programmes
Key aspects of effective training programmes include:
Use of lay people and health professionals as facilitators
Depending on the level on clinical content on the course, lay facilitators can prove very effective, acting as role models and creating the non-clinical environment to discuss other aspects of living with long term health conditions. Lay and clinical facilitators can also be very effective working in partnership.
Social learning environment
Feedback from participants on courses often highlights the benefits of meeting other people who are facing similar challenges. The opportunity to share and learn from each other in a facilitated environment is important.
Measuring quality and impact
There are numerous courses and programmes set up by local teams of health care and other professionals, and thus a national challenge is to ensure courses are appropriate both to local populations and individual needs and preferences.
Although patient programmes like the Expert Patient Programme and Co-Creating Health are well established, it is still important to collect data on individual courses being run locally, to ensure that quality is better understood and future programmes are designed and run in the way that best meets people’s needs.
The Guide to Quality Assurance developed by the Health Foundation as part of its Patient Skills Programme (Co-Creating Health) sets out the key elements that a quality assurance process should address and standards for each of these elements. QISMET is an independent body developed to support self-management providers and commissioners to achieve the highest possible quality service for people living with long-term health conditions.
Evidence shows that, without on-going support, people’s knowledge, skills and confidence to self-manage declines over time. Many courses therefore include creating peer support groups for people completing the course, and at the very least courses should support people to connect with peers and other forms of on-going support.
Find out more
- Learn about the Health Foundation’s Patient Skills Programme: The Health Foundation has developed its own programme to help people with long term conditions to develop the knowledge, skills and confidence they need to better manage their own condition and work in effective partnership with their clinicians. You can download all the materials to run the programme for free from this website.
- Read about how to set up and run courses and programmes for patients: Through the Health Foundation’s Co-creating Health programme, we have learnt a lot about how to plan and prepare for setting up a training programme for patients, recruit facilitators to run the training, recruit patients to attend and reduce the number of patients who drop out.
- Find out how to recruit and support trainers: Training people to self-manage is a skilled job and needs to be done by people who are properly trained, supervised and supported. The Health Foundation has developed guidance and materials to run training for trainers and supervise and support trainer.