There are lots of techniques that make self-management training for patients more effective, from recruitment to reducing drop-out rates.
In this section you can read learning from sites working on the Health Foundation’s Co-creating Health programme on how to:
- Set up a course or programme for patients
- Recruit, train and support facilitators
- Recruit and retain participants
- Ensure the workshops are effective
- Training trainers
Setting up a course or programme for patients
- Plan in advance the resources you will need to administer the classes, including providing initial information to participants considering enrolling, booking people onto specific programme workshops, sending out materials and handouts for each programme, issuing a register of participants to tutors, and following up with people who don’t attend.
- Consider how you might be able to link some of the issues that participants identify through to the work you are doing on improving the systems and processes the service uses. We found that the programme often identified ways that the service as a whole could better support people to manage their own condition, and that it was helpful to feed this learning through to the service development work. One way of doing this is to invite representatives from the programme to attend meetings about the service improvement work you are doing.
- Plan how you will evaluate the programme workshops. You may like to develop a simple evaluation tools such as an evaluation questionnaire of six or seven questions that tutors can give out and collect back in at the end of the session. This will help participants to reflect on what they have got out of the session and help keep an eye on how the sessions are going.
Recruiting, training and supporting facilitators
- You need to develop a pool of lay and clinical tutors able to deliver the programme who are well-trained in delivering this specific programme.
- Ensure you are regularly recruiting and training trainers as sites working on the Health Foundation’s Co-creating Health programme found that there was a rapid ‘turn over’ of tutors.
- Look at existing resources such as health trainers who may already have some of the basic skills.
- Ensure that you are clear with potential tutors about the time commitment they are making – for example how many courses you expect them to deliver - and explore how realistic this is before they commit to tutor training.
- It is preferable for lay tutors to have attended the programme themselves first before becoming tutors.
- Consider what support you will provide to tutors. Particularly for lay tutors, running the course may represent a significant physical, time and emotional commitment for the lay tutor. Consider how you will support and sustain them through this, including regular contact and a protocol for reporting problems. Can you draw upon external resources to provide supervision?
- Consider what support you will provide to tutors, particularly lay tutors – running the course may represent a significant physical, time and emotional commitment for the lay tutor. Consider how you will support and sustain them through this. Support should include regular contact and a protocol for reporting problems.
- Our Guide to Facilitator Training, Skills and Assessment includes detailed information on the core competencies of a facilitator, and how to recruit and train facilitators.
Recruiting and retaining participants
- Work with the service to define the type of patient you are trying to recruit. In theory any patient with the long term condition you are working on could be engaged in the programme, however, some programmes may be tailored to people who are newly diagnosed; others to people who have lived with a condition for several years, and you may want to think about other look variations.
- Allow plenty of time and energy to develop a multi-faceted plan to recruit participants. It can be hard to recruit people initially; developing a detailed plan using multiple approaches will help. Some ideas to support recruitment are included below.
- Identify the points in the patients pathway where you will try to recruit patients into the training. This ensures that appropriate patients are identified and offered the opportunity to get involved. For example, for chronic obstructive pulmonary disease (COPD) it may be useful to have patients diagnosed earlier by consultants, then followed in primary/community care. Self-management support for pain management may link to several consultant services.
- Ensure the process for finding out about and booking onto the Patient Skills Programme is ‘user friendly’ by establishing a single main point of contact.]Set up a database of people who have enquired about, are on, and have completed the programme
- Involve clinicians in recruiting their patients to the workshops. Successful approaches include having an Rx pad for healthcare professionals, discussing the classes and recruitment to them as part of any self-management support training you run for health professionals, and feeding back to clinicians on the programme about recruitment (we have found that practitioners are motivated to recruit more patients when they are able to compare their recruitment numbers to those of others). Asking clinicians to provide information about the classes in consultations and to write to patients can also be effective. Running self-management class taster sessions for clinicians (live or via DVD) will help them to better understand the classes, so that they can more confidently refer patients to this programme.
- Target patients who attend the GP practices where GPs are attending training in self-management support.
- Run taster sessions for service users (live or DVD) to help people choose to self-refer. Taster sessions may best be provided in places people naturally congregate eg GP surgeries, health centres etc.
- Include articles in your local press and community newsletters by clinicians and by people who have attended.
- Consider developing promotional materials you can distribute in local community facilities, such as beer mats, postcards and posters.
- Encourage and organise lay tutors to talk about the workshops to patients in local general practices, support groups and hospital clinics and at local events and conferences.
- Advertise the classes on the websites of practices where GPs have attended training in self-management support.
- Engage partner services and organisations in helping you to recruit participants, such as local community organisations and other health, local government and social care organisations.
- Consider the venue and timing carefully as accessibility can have a big impact on attendance. Issues such as the availability of parking nearby can be important. A successful approach has been to hold the workshops in GP practices. Although this helps recruitment, you may find that you need to pay for space within the practice!
- Plan and promote several series of classes at once, so people are able to choose the workshops that are held at a time and date that is convenient to them.
- Actively engage with participants before the workshops start, to ensure that once they have enrolled they actually attend. This might include writing to them with introductory materials and a reminder call prior to the first workshop. This approach can also help when people are at risk of dropping out because they lack confidence.
- Work with local communities and groups to help you reach out to people from diverse local communities.
- Consider how you can tailor the logistics of the classes for specific conditions to enable more people to attend. For example, people with COPD may find a series of classes set over a long period hard to attend, and the nature of depression makes it difficult to sustain people’s attendance.
- Consider establishing a ‘buddy system’ for participants, as this has been shown to help retain participants across the full series of workshops.
- Ask tutors to follow up with each participant individually at pre-arranged intervals during the class series, to help retain participants.
Effective delivery of the programme sessions
- Ensure both the clinical and lay tutor are able to attend all the classes. Modelling the partnership between health professional and patient is a central part of the course so it’s important that both the lay and health professional tutor lead every session. We have found participants really appreciate the different perspectives bought by the health professionals and lay tutors, and that the lay tutor can provide a role model to participants.
- Deliver the classes in an interactive way that encourages and supports discussion. It’s critical that the tutors stick to the materials they have been trained to use because these have been shown through research studies to be effective at improving people’s health. However, it is important that people have the chance to process this information and to apply their knowledge they acquire to themselves and their own lifestyle. Many of our participants found the opportunity to share information and self-management techniques and hear how other people cope, combined with the realisation that they are not the only ones experiencing difficulties, one of the most valuable aspects of the course.
- Use the classes to encourage family and friends to support participants’ self-management activities. This is because social support is important in maintaining people’s motivation to change. For example, participants could be encouraged to involve family and friends in their weekly goal setting and other ‘homework’ activities such as the gratitude diary.
- Consider how the content can be adapted to include plenty of condition-specific material. This can include extra resources such as leaflets and books, and drawing on the clinical tutor’s own knowledge. One approach is to combine the classes with existing site health education and rehabilitation programmes. However, you need to ensure that the information is provided alongside the support to develop people’s skills and confidence to self-manage, as research has shown that simply providing the information usually fails to translate into increased self-efficacy and behaviour change.
- Ensure that the sessions give sufficient emphasis to participants using the three enablers (goal setting, agenda setting and follow up) in consultations with their health professionals. If you also run the Practitioner Development Programme for clinicians which the Health Foundation has developed, this will mirror the approach clinicians learn in their development sessions, thus maximising the impact of both.
Training for trainers
- The facilitators are the single most important resource for any programme providing courses for people with long term conditions. It is therefore essential that the right people are recruited and that they are appropriately trained, supervised and supported to fulfil their role
- Trainers of trainers should have delivered a minimum of five workshops themselves and be fully conversant in behaviour change theory and practice including self-efficacy, patient activation and health literacy.
- You will need mechanisms to quality assure what they do and for refreshing learning.
- Consider whether it is possible, practical and effective to run training for trainers internally, or whether you need to commission an external organisation to run it for you.
- Work out how many trainers you think you need, to help you plan how many people you need to recruit to the course and how many courses you need to run.