Thesis (M.S.)--University of Michigan, 1994.

Thesis (Ph. D.)--University of Missouri--Columbia, 2002. / Typescript. Vita. Includes bibliographical references (leaves 80-89). Also available on the Internet.

Thesis (M.S.)--University of Michigan, 1994.

Thesis (MTech (Information Technology))--Cape Peninsula University of Technology, 2016. / Health information policies are constantly becoming a key feature in directing information usage in healthcare. After the passing of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 and the Affordable Care Act (ACA) passed in 2010, in the United States, there has been an increase in health systems innovations. Coupling this health systems hype is the current buzz concept in Information Technology, „Big data‟. The prospects of big data are full of potential, even more so in the healthcare field where the accuracy of data is life critical. How big health data can be used to achieve improved health is now the goal of the current health informatics practitioner. Even more exciting is the amount of health data being generated by patients via personal handheld devices and other forms of technology that exclude the healthcare practitioner. This patient-generated data is also known as Personal Health Records, PHR. To achieve meaningful use of PHRs and healthcare data in general through big data, a couple of hurdles have to be overcome. First and foremost is the issue of privacy and confidentiality of the patients whose data is in concern. Secondly is the perceived trustworthiness of PHRs by healthcare practitioners. Other issues to take into context are data rights and ownership, data suppression, IP protection, data anonymisation and reidentification, information flow and regulations as well as consent biases. This study sought to understand the role of data policies in the process of data utilisation in the healthcare sector with added interest on PHRs utilisation as part of big health data.

Indiana University-Purdue University Indianapolis (IUPUI) / BACKGROUND: The pathophysiology of diabetes mellitus and the need for vigilant monitoring of serum glucose levels lends itself well to prompt medical intervention by healthcare providers that can significantly reduce morbidity and mortality and improve patient quality of life. The effect of intervention in diabetes can be assessed by following objective laboratory measurements such as hemoglobin A1C, which is abnormal with poorly controlled diabetes and returns to normal with proper management. There are mobile technologies now available that allow for self-monitoring and intervention in this patient population. Using a systematic approach this paper will assess the benefits of Short Message Services and mobile technology in managing patients with diabetes and improving adherence and other outcomes. OBJECTIVE: To assess the benefits and disadvantages the use of mobile technology could have in the management of diabetes. METHODOLOGY: A systematic review of articles on this topic was performed. A total of 759 articles were initially identified by searching various search engines, from which only 39 articles met all of the inclusion/exclusion criteria of this systematic review. FINDINGS: The initial review of literature indicated that the use of mobile technology in patients with diabetes resulted in improved disease outcomes as indicated by parameters such as a decrease in hemoglobin A1C, and an increase in sustainable blood glucose levels. CONCLUSION: Mobile technology is found to be a promising tool in the management of diabetes, but further research is needed because there is a lack of reliable studies, trials, and systematic reviews. Physicians and other healthcare professionals are rapidly adopting mobile technology for use in clinical practice because they understand the rising phenomenon of mobile technology.

Thesis (Ph.D. (Psychology)) -- University of Limpopo, 2022 / This thesis is about evaluating the effectiveness of a self-care programme for intervention in burnout and compassion fatigue among nurses working in critical care areas. A convenient sampling method of all the nurses who work in the critical care areas as per the operational definition of terms for this study was used. A total of 154 nurses in a critical care area participated in this pre-post study, of which (n=83) were CTOP Nurses and (n=71) were Forensic Nurses. The nurses completed a biographical questionnaire, the Professional Quality of Life Scale (ProQOL R-IV), the Empathy Assessment Index Scale (EAI). Nurses were divided into groups of 6 to 10 people for focus group discussions on their work experiences. The results of the current study indicated moderate to high levels of burnout and compassion fatigue occurring with high compassion satisfaction among the nurses. However, the mean burnout scores for CTOP nurses and Forensic nurses and details indicated lack of statistically significant difference post-intervention (p>0.05). The study utilized the Context Process Outcome (CPO) model as its framework. The proximal outcomes centred around safe holding, development of awareness and self-care. Intermediate outcomes consisted of drop in burnout and compassion fatigue and the distal outcomes showed increase in empathy and revived motivation to continue work in critical areas as well as a drop in distress and increase in compassion satisfaction. The project was ground-breaking work of research with nurses in the critical areas with regards to health promotion with promise in healthier ways of caring for the carers and their empowerment and intervention outlook on the challenges around working environment stressors and interventions. Such work could in future benefit health care professionals by predicting possible decrease in their productivity by measuring other non-invasive constructs like empathy which has shown probable predictive power on development of burnout and compassion fatigue as well as improvement of satisfaction. Future research is recommended for inclusion of other health professions in such work and not only nurses, as well as doing evaluation that allows intermittent re-alignment whenever indicated in the process of intervention

COVID-19 exacerbated a pre-existing and well-documented mental health crisis on college campuses in the United States. During COVID-19, more college students than ever before in recorded history reported feelings of anxiety and depression, among other mental health issues. There are myriad possible causes for the decline in mental health among college students. One clear cause is the introduction of the smartphone, its widespread adoption, and its frequent use by college-age people. Research also revealed that an unprecedented number of college students are completely disconnected from religion and spirituality. Studies demonstrated that cultivating a religious or spiritual life can be beneficial for one’s mental well-being. The efforts on college campuses to provide mental health resources for students would benefit from additional support. This care should be accessible to more students and should combat the unfortunate stigma around receiving help for mental health. Undergraduate introductory philosophy courses taken as a requirement by various majors can serve as responses to this call for additional care. These classes are inherently accessible and can offer students an engaging experience with self-care by implementing exercises inspired by philosophy as the art of living. Although philosophy as the art of living does not necessarily have to replace religion or other forms of mental health care, it can offer an experience that is of therapeutic value in the classroom. This tradition has a rich, ancient history of intending to serve this purpose. The objective of this research was to present and examine self-care exercises from philosophy as the art of living and to evaluate how these can be taught in the college classroom in response to the mental health crisis on college campuses. It also aimed to render the experience of teaching these exercises. The research was executed through a hermeneutical and phenomenological approach. The phenomenological methodology was performed by a teacher in the form of a self-study. It was also conducted with the teacher as a witness to what transpired in introductory philosophy classes with thousands of students in dozens of individual classes in a diverse metropolis. A college introductory philosophy course in this epoch of mental health crisis on campuses should abide by philosophy as the art of living’s imperative to decrease suffering. There is a vital need for additional resources to respond to the decline in mental wellness among students. The results of this research demonstrated that philosophy as the art of living and its emphasis on exercises can be successfully applied to the college classroom. In this research, students were given time on a regular basis during class to be in silence, confront Socratic-style questions that encouraged them to examine and care for themselves, practice self-writing to heighten their ability to think and pursue the aim of self-care, and then read to engage with philosophical texts to support their self-care. Students consistently and rigorously engaged with these exercises. Their time spent in silent practice provided an opportunity for therapeutic, meditative, and peaceful reflection. Educators should consider implementing these exercises in introductory philosophy classes and beyond as ways to offer self-care to students who may be struggling with their mental health, as so many are.

由於慢性疾病的流行程度有著全球性上升的趨勢，它經已成為一個公共衛生的問題，為醫療系統帶來沉重的負擔。慢性疾病的發病率以老年人為最高，慢性疾病對老年人的生理、心理、社交及經濟等，構成尤其嚴重的後果。由於香港的人口持續老化，所以預計患有慢性疾病的人口數目在將來幾十年會不斷增加。但是，現時對患有慢性疾病的老年人所提供的照顧不足，再加上本地老年人擁有的多種特徵，例如社會經濟地位較低，健康讀寫能力較弱，及同時患有多重疾病，都有可能對醫護人員提供的護理造成障礙。提升慢性病患者掌管健康的能力，例如提供自我管理的支援，增強他們的信心，及協助他們作出有關健康的判斷及決策，有機會能解決慢性疾病所引起的問題。雖然過往的研究已經發現自我管理教育課程能夠改善慢性病患者的生理、心理及社交健康，及提升患者的健康行為，可是這類課程對老年人的成效，依然缺乏足夠科研證據的支持。 / 作者在這論文中進行了兩項研究，去探討自我管理教育課程對患有慢性疾病的長者的健康行為、生理、心理、社交、生活質素及醫療服務的使用的影響。甲項研究是一個半實驗性研究，探討¬「慢性疾病自我管理課程」對患有不同種類慢性疾病的長者的效果。乙項研究是一個隨機控制實驗，研究「糖尿病自我管理課程」對患有非胰島素依賴的長者的效果。 / 甲項研究招募了患有一種或以上慢性疾病，及居住在社區的長者進行研究。三百零二名治療組的參加者接受了一個為期六星期的「慢性疾病自我管理課程」，當中包括六課以小組模式進行的課堂，每堂為兩小時三十分。課程由專業人員或非專業的長者義工組長帶領。二百九十八名對照組的參加者則繼續接受六個月慣常的護理。每位參加者都會在基線及六個月後接受測試，測試包括自我管理行為、自我效能感、健康狀況及醫療服務的使用。 / 利用單向共變數分析法，結果顯示治療組的所有的自我管理行為和自我效能感測試都有顯著改善 (p < .05)。在十項健康狀況測試中，有五項有明顯改善 (p < .05)。另外，醫療服務的使用則沒有明顯改變。 / 乙項研究是利用隨機方法，分別把九十位及八十七位患有非胰島素依賴的長者分配到治療組及對照組。治療組的參加者參與了為期八堂，每星期一堂，每堂兩小時的「糖尿病自我管理課程」。對照組參加者則在八星期內繼續接受慣常的護理。所有參加者都會在基線及八星期後接受測試，測試包括身高體重指數、腰臀比例、血糖及血壓水平、糖尿病相關的認識、糖尿病指定及總稱的生活質素、及營養攝取。 / 利用單向共變數分析法，結果顯示治療組的糖尿病相關的認識 (p < .0005)，糖尿病指定生活質素的滿意分類 (p = .045)，及總稱生活質素的精神健康分類 (p = .003)皆有明顯的改善。治療組的總能量 (p = .018)及飽和脂肪攝取 (p = .03)都有明顯減少。在各生理及人體測量指標及其他生活質素測試，則沒有明顯改變。 / 此研究增加對疾病指定及非疾病指定的自我管理教育課程於社區上患有慢性疾病的長者的成效的認識。研究結果發現針對長者而設計的課程有機會改善長者的行為、心理及社交狀況，長者亦可以通過課程學習自我管理技巧及改變健康行為，從而改善健康。由長者義工組長帶領的課程有可能跟由專業人員帶領的課程的效果相近。研究結果象徵著自我管理課程需要融入醫療系統的慣常服務當中，以達致最大的成效。本論文亦為如何於各個護理層面及本地環境推行自我管理課程作出詳細討論。對於將來的研究發展，本論文建議加長跟進測試的時間及利用更大的實驗樣本探討自我管理課程於長者身上的成效，疾病指定及非疾病指定課程的效果亦需要作出比較，個別自我管理課程的特徵對課程成效的影響亦需要詳盡地探討。 / The global epidemic of chronic disease has become a public health issue and created a huge burden on health care systems and societies. Older population is highly susceptible to chronic disease. The high prevalence of chronic disease among older adults results in a series of physical, psychosocial and financial consequences in this patient group. In Hong Kong, as the population continues to age, the number of people having chronic disease is expected to increase rapidly in next few decades. The care for older adults with chronic disease is yet suboptimal. Local older people are predisposed to a number of characteristics, such as low socioeconomic status, poor health literacy and multiple morbidities, which may hinder professionals to provide effective care. Empowering patients through supporting self-management, increasing confidence and assisting decision-making of people with chronic disease has been found to be a solution to the problem. Although literature has suggested that self-management education programmes may improve physical and psychosocial outcomes, and promote health-related behaviours among people with chronic disease, the evidence of the effects of such programmes in older adults is still lacking. / Two studies have been conducted to examine the effects of self-management education programmes in improving health behaviours, physical and psychological status, quality of life and health care utilization in older people with chronic disease. Study One is a quasi-experimental trial exploring the effects of the Chronic Disease Self-Management Programme (CDSMP) in older adults with a wide range of chronic diseases. Study Two is a randomized controlled trial evaluating the effects of the Diabetes Mellitus Self-Management Programme (DMSMP) in older adults with non-insulin-dependent diabetes mellitus. / In Study One, community-dwelling older people with one or more chronic disease were recruited. The intervention group (n = 302) received the 6-week CDSMP, which consisted of 6 group sessions with each session lasting for 2.5 hours. The programme was facilitated either by professional and older lay leaders. The control group (n = 298) continued their usual care for 6 months. Self-management behaviours, self-efficacy, health status, and health care utilization of participants were assessed at baseline and 6 months. / The one-way analysis of covariance showed that the intervention group has significant improvements in all self-management behaviours and self-efficacy outcomes, and 5 out of 10 health status measures (all p < .05). No significant change was detected in the use of health care services. / In Study Two, older people with non-insulin-dependent diabetes mellitus were randomly assigned to either the intervention (n = 90) or control (n = 87) group. The intervention group attended the DMSMP comprising 8 weekly 2-hour sessions. The control group received usual care for 8 weeks. Body mass index, waist-to-hip ratio, blood glucose and blood pressure levels, diabetes-related knowledge, disease-specific and generic quality of life, and nutritional intakes were measured at baseline and 8 weeks. / Using the one-way analysis of covariance, the intervention group found significant improvements in diabetes-related knowledge (p < .0005), the satisfaction subscale score in the diabetes-specific quality of life measure (p = .045), and the mental health score in the generic quality of life measure (p = .003). Significant reductions of total energy (p = .018) and saturated fat intakes (p = .03) were also demonstrated in the intervention group. No significant change was detected in the physiological outcomes, anthropometric indices and other quality of life and nutritional measures. / The present studies enrich the knowledge of the effects of disease-specific and generic self-management education programmes for older adults with chronic disease living in the community. It demonstrated that the programmes specifically tailored for older adults may improve a wide range of behavioural and psychosocial outcomes. Older adults may be able to learn new skills for self-management and change behaviours to improve their health. The effects of using older lay persons to lead such programmes may be similar with those using professional staff. The findings imply that self-management programmes need to be integrated into the routine service of health care systems and community care in order to have maximal effects. The implementation of self-management support at different levels of care and under the local context was discussed. Further studies should be conducted to explore the effects of self-management programmes on older people using prolonged follow-ups and larger sample size. The comparative effects of disease-specific and generic self-management programme should be evaluated. The individual influences of various essential features of self-management interventions need to be determined explicitly. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Chan, Lap Sun. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 265-302). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; some appendixes also in Chinese. / Chapter CHAPTER ONE --- INTRODUCTION / The epidemiology of chronic disease --- p.1 / Causes of the epidemiology of chronic disease --- p.3 / Risk factors of chronic disease --- p.4 / Self-management approach in managing chronic disease --- p.5 / The research problem --- p.8 / Chapter CHAPTER TWO --- LITERATURE REVIEW / Challenges in managing chronic disease --- p.10 / Specific concerns for older people --- p.12 / Chronic disease management --- p.16 / Introduction --- p.16 / Patient-centred care --- p.18 / Frameworks for improving care of chronic disease --- p.20 / Chronic Care Model --- p.20 / Innovative Care for Chronic Conditions --- p.22 / Service delivery model of chronic disease management --- p.24 / Global strategies in chronic disease management --- p.26 / Empirical evidence of the Chronic Care Model --- p.29 / Self-management --- p.34 / Definitions --- p.34 / Conceptualizing self-management --- p.37 / Patient-professional relationship --- p.37 / The goal of self-management --- p.40 / Self-management tasks and skills --- p.41 / Perspectives and barriers of self-management in older adults with chronic disease --- p.44 / Self-management education and support --- p.50 / Introduction --- p.50 / Comparison with traditional patient education --- p.51 / Characteristics of self-management education --- p.53 / Theoretical basis in self-management education --- p.53 / Self-efficacy theory --- p.56 / Teaching problem-solving skills and making action plans --- p.58 / Individualizing self-management education --- p.59 / Continuity of self-management support --- p.60 / Framework of delivering self-management support services --- p.62 / Global implementation of self-management education --- p.65 / Empirical evidence of the effects of self-management interventions --- p.70 / Effects of self-management interventions in general --- p.71 / Effects of self-management interventions for older adults with chronic disease --- p.77 / Effects of self-management interventions for patients with chronic disease in Hong Kong --- p.85 / Methodological issues in self-management studies --- p.88 / Establishing self-management interventions for older adults --- p.90 / Establishing self-management interventions under the local context --- p.93 / Summary of Literature Review --- p.94 / Chapter CHAPTER THREE --- METHODS (STUDY ONE) / Introduction --- p.97 / Methodology --- p.98 / Research objectives --- p.98 / Null hypotheses --- p.99 / Study design --- p.100 / Participants --- p.101 / Recruitment and procedure --- p.101 / Intervention --- p.103 / Adaptations of programme delivery for local older participants --- p.106 / Sample size calculation --- p.107 / Outcome measures --- p.108 / The questionnaire --- p.108 / The Abbreviated Mental Test, Hong Kong version (AMT) --- p.109 / Frailty Index (FI) --- p.109 / Statistical analysis --- p.112 / Primary analysis --- p.112 / Secondary analysis --- p.112 / Focus group --- p.114 / Chapter CHAPTER FOUR --- RESULTS (STUDY ONE) / Participants --- p.116 / Baseline --- p.118 / Comparing baseline and 6 months outcomes of intervention group --- p.123 / Comparing baseline and 6 months outcomes of control group --- p.125 / Comparing outcomes between intervention and control groups at 6 months --- p.127 / Subgroup analysis --- p.130 / Comparison among age subgroups --- p.132 / Comparison among education level subgroups --- p.133 / Comparison among frailty level subgroups --- p.133 / Comparing professional staff-led and older lay-led programmes at 6 months --- p.140 / Focus group --- p.142 / Chapter CHAPTER FIVE --- DISCUSSION (STUDY ONE) / Introduction --- p.145 / Demographics characteristics --- p.145 / Baseline outcomes --- p.147 / Effects of the CDSMP on older adults with chronic disease --- p.148 / Self-management behaviours and self-efficacy --- p.148 / Health status --- p.148 / Health care utilization --- p.149 / Comparing with existing literature --- p.150 / Effects of age, education level and frailty level on the outcomes --- p.154 / Age --- p.154 / Education level --- p.154 / Frailty level --- p.155 / Effects of leaders on the outcomes --- p.156 / Qualitative findings --- p.157 / Feasibility of training older people to be lay leaders --- p.160 / Summary of the discussion --- p.162 / Chapter CHAPTER SIX --- METHODS (STUDY TWO) / Introduction --- p.164 / Methodology --- p.166 / Research objectives --- p.166 / Null hypothesis --- p.166 / Study design --- p.167 / Pilot study --- p.168 / Participants --- p.169 / Recruitment and procedure --- p.170 / Intervention --- p.172 / Educational talks --- p.174 / Exercise practice --- p.174 / Goal setting and problem-solving --- p.177 / Issues of designing self-management programme for local older adults --- p.177 / Sample size calculation --- p.178 / Outcome measures --- p.179 / Diabetes Knowledge scale (DKN) --- p.179 / 24-hour food recall --- p.180 / Anthropometric measurements --- p.181 / Clinical health indicators --- p.182 / Quality of life --- p.183 / Statistical analysis --- p.185 / Primary analysis --- p.185 / Secondary analysis --- p.186 / Focus group --- p.186 / Chapter CHAPTER SEVEN --- RESULTS (STUDY TWO) / Participants --- p.188 / Baseline --- p.190 / Comparing baseline and 8 weeks outcomes of intervention group --- p.193 / Comparing baseline and 8 weeks outcomes of control group --- p.195 / Comparing outcomes between intervention and control group at 8 weeks --- p.197 / Nutritional intakes --- p.200 / Comparing baseline, 8 weeks and 6 months outcomes of intervention group --- p.203 / Focus group --- p.206 / Chapter CHAPTER EIGHT --- DISCUSSION (STUDY TWO) / Introduction --- p.208 / Demographics characteristics --- p.209 / Baseline outcomes --- p.210 / Effects of the DMSMP on older adults with type 2 DM --- p.213 / Knowledge and nutritional intakes --- p.213 / Anthropometric measures and clinical health indicators --- p.214 / Quality of life --- p.217 / Long-term effects of the DMSMP on intervention group participants --- p.219 / Comparing with existing literature --- p.220 / Comparing with a local study --- p.226 / Qualitative findings --- p.227 / Summary of the discussion --- p.231 / Chapter CHAPTER NINE --- CONCLUSION / Overall effects of self-management interventions for older adults with chronic disease --- p.232 / Strengths of the study --- p.238 / Using a more stringent study design --- p.238 / Incorporated essential features of self-management interventions into current programmes --- p.239 / Demonstrated a collaborative model between health and social sectors --- p.240 / Limitations of the study --- p.241 / The integrity of study sample --- p.241 / Issues in the representativeness of study sample --- p.241 / High attrition rate in the longitudinal follow-up (The DMSMP) --- p.243 / Unknown uptake rate --- p.244 / The study design --- p.244 / Non-randomized allocation of participants (The CDSMP) --- p.244 / The lack of control for attention effect --- p.246 / The implementation of study intervention --- p.247 / Using multiple components --- p.247 / The absence of blinding (The DMSMP) --- p.248 / The evaluation and statistical analysis --- p.248 / Short duration of follow-up --- p.248 / Limitations of post-hoc analyses --- p.249 / Diffusion of self-management interventions for older adults --- p.250 / Considerations to the adoption of current self-management interventions --- p.251 / Relative advantage --- p.251 / Compatibility --- p.251 / Complexity --- p.252 / Trialability --- p.252 / Observability --- p.253 / Experience of implementing self-management interventions in the UK and the US --- p.254 / Considerations to the implementation of current self-management interventions --- p.256 / Strategies applied in promoting the adoption and implementation of current self-management interventions --- p.257 / Recommendations for local implementation of self-management interventions --- p.259 / Recommendations for future research --- p.261 / Conclusion --- p.264

The aim of this study was to explore and describe the experiences of diabetes mellitus patients at the Piggs Peak Hospital in Swaziland, from the time of diabetes diagnosis to living with diabetes, adherence to treatment and implementing diabetes self-care. A descriptive, exploratory, contextual qualitative research was conducted. Data was gathered through semi-structured interviews with 26 participants purposively selected on diabetes days at the hospital. Data was analysed qualitatively. Results revealed that patients present late for diagnosis. Being diagnosed causes psychological distress of varying intensity and duration. Hospital visits are burdensome due to financial and transport challenges, as well as service shortcomings. Self-care activities are difficult due to financial challenges and nonconducive social circumstances at home. Social support is lacking. Diabetes patients fear insulin use and prefer oral tablets. It is concluded that diabetes self-care is burdensome for most patients of the PPH in Swaziland. The service providers, stakeholders, and government need to explore strategies for mitigating effects of various barriers to self-care as revealed in this study. / Health Studies / M.A. (Public Health)

Objective: The promotion of self-management support for people with LTCs is a health policy priority across the UK (LTCAS 2008; DoH 2012). Self-management support is designed to change and improve care for people with LTCs, who form an increasing proportion of the population requiring healthcare and treatment. For health organisations models of care, which support self-management, require greater emphasis on person-focused rather than disease-focused manifestations of health and represents a new model of care delivery requiring changes in practice. Current research demonstrates that health policies are increasingly complex, involve multiple organisations and often fail to translate into effective practice (Noyles et al. 2014). The deficit between what works and what happens in practice is referred to as the “implementation deficit” (Pressman and Wildasky 1984) and traditionally it has been difficult to breakaway from the idea that the policy process is best viewed from the top-down (Barett and Fudge 1981). However, there remains a need to understand the processes of implementation, which takes account of the variation, the multiple layers and interactions which takes place between policy-maker and -implementer as policy becomes practice (Hupe 2011). Implementation of self-management is a contemporary focus in UK health policy and this thesis explains what processes are used to implement self-management policy for people with LTCs into everyday practice in one health board. Methods: A case study approach was used to investigate the policy process with data collected using thirty-one semi-structured interviews with policy-makers and regional and local policy-implementers plus eight hours of observation of national and regional policy meetings. To provide context to the implementation process data also included thirteen policy documents. Data analysis used the retrospective application of NPT as a theoretical framework with which to explore the implementation processes. NPT is an emerging theory that is being promoted as a means of understanding implementation, embedding and integration of new ideas in healthcare (McEvoy et al. 2014). The application of NPT focuses on four mechanisms, termed work (May and Finch 2009: 547), which promote incorporation of new ideas in practice. These areas of work are coherence, cognitive participation, collective action and reflexive monitoring (Mair et al. 2012). Findings: The findings suggest that there are a number of important influences operating behind or as part of the policy implementation process. These included the need for a shared understanding, getting stakeholders involved to drive forward policy, work promoting collaboration and participation was the most detailed and important in the process of policy implementation; the course of policy was affected by factors which facilitated or inhibited stakeholders acceptance of self-management; and NPT fosters key analytical insights. Conclusion: Understanding the process of policy implementation in healthcare and how practice changes as a result of policy is subject to a wide range of influences. What emerges are five key recommendations relating to understanding policy implementation. (1) understanding the concept of self-management is important in promoting policy implementation. This understanding benefits from dialogue between policy-makers and -implementers. (2) stakeholder involvement supports implementation particularly the role of clinical leadership and leadership through existing networks but also value in establishing new organisational structures to create a receptive context. (3) develop participation and collaboration through use of the patient voice which helped simplify the policy message and motivate change. (4) other resources help policy implementation and where these are evident then policy is implemented and where they are absent then implementation is not embedded. Lack of evidence was a particular area of constraint. (5) NPT has shown that social context is important, and provides for this. But in addition there is evidence that historical perspectives and previous experience are also important influence on receptivity to implementation. This research contributes to the development of theory and practice in the area of implementation science. The exploration of the policy implementation has revealed the action and work which policy-makers and -implementers are engaged in while implementing policy. It has tested the utility of NPT in a real-life setting using all four mechanisms.