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No / Mainstream health psychology supports neoliberal notions of health promotion in which self-management is central. The emphasis is on models that explain behaviour as individually driven and cognitively motivated, with health beliefs framed as the favoured mechanisms to target in order to bring about change to improve health. Utilising understandings exemplified in critical health psychology, we take a more socially situated approach, focusing on practicing health, the rhetoric of modernisation in UK health care and moves toward democratisation. While recognising that within these new ways of working there are opportunities for empowerment and user-led health care, there are other implications. How these changes link to simplistic cognitive behavioural ideologies of health promotion and rational decision-making is explored. Utilising two different empirical studies, this article highlights how self-management and expected compliance with governmental authority in relation to health practices position not only communities that experience multiple disadvantage but also more seemingly privileged social actors. The article presents a challenge to self-management and informed choice, in which the importance of navigational networks is evident. Because health care can become remote and inaccessible to certain sections of the community, yet pervasive and deterministic for others, we need multiple levels of analysis and different forms of action.

Yes / Technology has the potential to provide support for self-management to people with congestive heart failure (CHF). This paper describes the results of a realist evaluation of the SMART Personalised Self-Management System (PSMS) for CHF. Methods The PSMS was used, at home, by seven people with CHF. Data describing system usage and usability as well as questionnaire and interview data were evaluated in terms of the context, mechanism and outcome hypotheses (CMOs) integral to realist evaluation. Results The CHF PSMS improved heart failure related knowledge in those with low levels of knowledge at baseline, through providing information and quizzes. Furthermore, participants perceived the self-regulatory aspects of the CHF PSMS as being useful in encouraging daily walking. The CMOs were revised to describe the context of use, and how this influences both the mechanisms and the outcomes. Conclusions Participants with CHF engaged with the PSMS despite some technological problems. Some positive effects on knowledge were observed as well as the potential to assist with changing physical activity behaviour. Knowledge of CHF and physical activity behaviour change are important self-management targets for CHF, and this study provides evidence to direct the further development of a technology to support these targets.

Yes / A study to determine the feasibility of conducting a future population-based trial into a selfmanagement intervention for community-living adults with early stage dementia included evaluation of intervention content and modes of delivery, staffing requirements, recruitment methods and the utility and usability of patient reported outcomes. Methods: Participants identified through memory clinics in one city took part in an intervention called ‘Journeying through Dementia’. The 12-week programme incorporating four individual sessions with one of the facilitators encourages participants to engage in discussion and activities related to health and well-being positioning them as the expert enabling long-term behavioural change. Participants (n = 10) and their nominated carers (n = 7) were all asked to complete selected outcomes at baseline, 8 weeks (participants only) and post intervention and invited to comment on their usability. All participants and carers were qualitatively interviewed before intervention delivery about their expectations and participants; nominated carers and facilitators were all interviewed after cessation about their experiences. Results: The manualised intervention and modes of delivery proved acceptable to participants and carers. Reported benefits included increased confidence and self-efficacy, engagement in new or lapsed activities and reengagement in fun and friendships. People with dementia and carers were able to self-complete all outcome measures, but time required to complete the measures is a key factor. Strategies for recruitment need to include direct contact within 24–48 h post invitation to the study. Analysis of data on the primary outcome did not reveal any trends. Facilitators found the training and support to be appropriate and helpful. Conclusions: The tailored intervention reportedly met the needs of all participants. The study confirmed the need for careful identification and application of patient-reported outcome measures. Outcomes to measure some dimensions of reported benefit are not available. / The study was supported and funded by the Medical Research Council (MRC) Lifelong Health and Wellbeing (LLHW) programme; grant number G1001406, ISRCTN is 67209155.

Yes / Stroke is the leading cause of adult disability in the UK. Many stroke patients report a feeling of ‘abandonment’ when they are discharged from therapy services. This in turn, leads to readmissions and re-referrals to both hospital and community services. This paper discusses the components of E-health and how E-health could be used to supplement conventional interventions to improve patient engagement, empowerment and decreased reliance on therapy services. In doing so it will consider how such interventions could better involve carers. An integrated E-health approach has the potential to improve outcomes for stroke survivors. A person centred approach needs to be employed through partnerships between stroke survivor, carer and healthcare professional. Remote monitoring could provide specific targeted interventions, preventing unnecessary hospital admissions or re-referrals and reducing cost of care. While the issues are well defined more work is required on what these integrated, patient centred E-health solutions may look like in order to be successful in supporting stroke survivors. / The full-text of this article will be released for public view at the end of the publisher embargo on 11 Apr 2018.

Altering driver's goals and motives for at-risk driving is likely to reduce the frequency of at-risk driving behaviors and their associated crashes and injuries. However, most driving occurs when people are alone with little supervisions or accountability. Thus, a self-management for safety (SMS) intervention may be the most appropriate technique to decrease at-risk driving behaviors. The current research evaluated an SMS process with college students on a simulated driving task. Participants included 93 university students (41 males, 52 females) randomly assigned to one of three groups (31 participants per group). Participants in the Control group did not receive any of the intervention materials; they were instructed to drive as they normally drive on each trial. Participants in the Self-Monitoring + Objective Feedback group received objective feedback from the experimenter about their actual performance on the target driving behavior as well as personal feedback from their self-monitoring forms. These participants recorded their individual improvement goals on the targeted driving behavior. Participants in the Self-Monitoring group recorded their individual improvement goals on the targeted driving behavior, but received only personal feedback from their self-monitoring forms. Similar to past self-management interventions directed at increasing safety-related driving behavior (Hickman & Geller, in press; Krause, 1997; Olson & Austin, 2001), SMS led to clear improvement in subsequent safety performance. Based on the recorded driving behaviors of 93 participants, SMS was effective in increasing the mean percentage of total driving time traveling below the posted speed limit compared to a Control group that did not receive any of the SMS components. Across the four trials, participants in the SM and SM + OFB group significantly increased the percentage of total driving time traveling below the posted speed limit by 13.4 (18.3%) and 14.5 (19.8%) percentage points, respectively, compared to participants in the Control group. / Ph. D.

Bakgrund: Smärta är en multidimensionell och subjektiv upplevelse som kan drabba alla människor. Smärta är den vanligaste orsaken till uppsökande av sjukvård samt orsakande av funktionsnedsättningar och oförmåga att arbeta. Personer med långvarig smärta måste självständigt utföra en stor del av sin behandling och omvårdnad i form av egenvård. Det ingår i sjuksköterskans uppdrag att uppmuntra och stödja patienter till att utföra egenvård, dock finns ingen entydig definition av begreppet egenvård. Syfte: Att redogöra för hur personer med långvarig smärtproblematik beskriver egenvård. Metod: En litteraturöversikt baserad på tio vetenskapliga artiklar med kvalitativa och kvantitativa ansatser. Artiklarna togs fram via sökningar i databaserna CINAHL Complete och MEDLINE, och var publicerade mellan åren 2005-2015. Artiklarna har analyserats enligt Fribergs analysmetod. Resultat: Resultatet i litteraturöversikten presenterade att personer med långvarig smärta beskrev egenvård som multidimensionell. Egenvård ansågs bestå av personliga förmågor samt mentala och praktiska strategier. Personer med långvarig smärta ansåg även att utbildning och stöd ifrån hälso- och sjukvården var viktigt för utförandet av egenvård. Diskussion: Resultatet har diskuterats utifrån Dorothea Orems omvårdnadsteori om egenvårdsbalans samt vetenskapliga publiceringar. Egenvårdens innebörd för personer med långvarig smärta har jämförts med de olika definitioner av egenvård som tillämpas inom hälso- och sjukvården. Vidare har egenvårdsdefinitionernas betydelse för hälso- och sjukvårdens egenvårdsstödjande insatser diskuterats. / Background: Pain is a multidimensional and subjective experience that can affect anyone. Pain is the most common reason to seek medical care and is the main cause to disability and inability to work. People with chronic pain need to independently manage a large part of their treatment and care in the form of self-management. One part of the nursing role is to encourage and support patients to perform self-management, however there is no clear definition of the term self-management. Aim: To illustrate how people with chronic pain describes self-management. Method: The literature review was based on ten scientific articles, with qualitative and quantitative approaches. The articles were found through searches in the databases CINAHL Complete and MEDLINE, with publication between the years 2005-2015. The articles were analyzed using Fribergs method of analysis. Results: The literature review showed that people with chronic pain described that self-management was multidimensional. Self-management was considered to involve both personal abilities, mental and practical strategies. People with chronic pain also believed that education and support from healthcare was essential for self-management. Discussion: The result has been discussed against Dorothea Orems nursing theory about self-care and relevant scientific publications. The ​​meaning of self-management for people with chronic pain has been compared with various definitions of self-management that are applied in healthcare. Furthermore the definitions of self-management were put in relation to how the healthcare provide supporting self-management interventions.

The purpose of this study was to investigate the effects of self-management strategies as a means of reducing off-task and disruptive behaviors of elementary school children identified as emotionally disturbed or behavior disordered (E/BD). This study provided a practical approach for classroom teachers to implement self-management strategies in classes that include children identified as having E/BD. Five elementary school children who were formally evaluated and enrolled in a special education classroom for students with E/BD were selected to participate in the study. The study also examined the effects of the self-management procedures when targeted behaviors were monitored by peers. Four resource students from the regular education class served as peer monitors. An ABAB reversal design was used to assess the effectiveness of the self-management strategy in the special education classroom. A behavior rating scale was used at the beginning of the study to develop a baseline of student behavior and during the final phase of the intervention to measure progress. The data indicated that the self-management strategies decreased the levels off-task and disruptive behaviors for all participating students. The findings of this study substantiates previous research that suggests self-management techniques help student to manage their own behaviors.

Bakgrund: Diabetes typ 2 är en kronisk sjukdom som ökar kraftigt i världen. Behandlingen grundar sig i livsstilsrelaterade åtgärder som ofta innebär en förändring av kost- och motionsvanor. Egenvård vid kronisk sjukdom beskrivs som en process som påverkas av olika faktorer. Sjuksköterskan har en viktig uppgift i att stödja personen i denna process utifrån varje individs behov och erfarenheter. För att kunna ge adekvat stöd är det betydelsefullt att få en ökad förståelse av upplevelsen av egenvård vid diabetes typ 2. Syfte: Syftet var att beskriva upplevelsen av egenvård hos personer med diabetes typ 2. Metod: En litteraturöversikt genomfördes baserat på tio kvalitativa artiklar hämtade från databaserna CINAHL och PubMed. Artiklarna analyserades och de likheter som identifierades lyftes fram och bildade nya teman. Resultat: Det övergripandet temat som representerar hela resultatet är upplevelsen av en inre kamp. Temat beskriver hur egenvården upplevs som en ständig kamp där sjukdomens krav vägs mot vad som är betydelsefullt i livet. Subtemat, upplevelsen av att integrera egenvården i vardagen berör egenvårdsprocessen. Resterande subteman; sociala relationers betydelse för egenvården, informationens och kunskapens betydelse för egenvården och den psykiska och fysiska miljöns betydelse för egenvården beskriver vad som underlättar samt försvårar integration av egenvård i dagliga livet. Diskussion: Författarna diskuterar svårigheter med att integrera nya vanor i livet och vad som påverkar egenvårdsprocessen. Diskussionen berör bland annat autonomi, syn på framtiden och behovet av att skapa kontroll över sin livssituation. Diskussionen knyter även an till Meleis' transitionsteori. / Background: Type 2 diabetes is a chronic disease that is increasing worldwide. The treatment is based on lifestyle-related measures that often mean a change in diet and exercise habits. Self-management in chronic illness is described as a process that is influenced by various factors. Nurses have a key role in supporting the person in this process based on each individual's needs and experiences. In order to provide adequate support, it is important to get a better understanding of the experience of self-management in type 2 diabetes. Aim: The aim was to describe the experience of self-management among people with type 2 diabetes. Methods: A literature review based on ten scientific articles. All articles were qualitative and found in the databases CINAHL and PubMed. The articles were analyzed and the similarities were highlighted and created new themes. Results: The overall theme representing the result is the experience of an inner struggle. The theme describes how self-management is experienced as a constant struggle between the disease demands and what is valuable in life. The sub-theme, the experience of integrating self-management in daily life, affects the self-management process. The remaining sub-themes describe the barriers to and facilitators of integrating self-management in daily life. Discussions: The authors discuss the difficulty of integrating new habits in life and what influences the process. The discussion includes autonomy, view of the future and the need to gain control. The discussion also relates to Meleis' Transition Theory.