Knowledge sharing to support long term condition self-management - patient and healthcare professional perspectives

Background: Increased self management is a suggested solution to the burden on healthcare services of long term conditions (LTCs). This requires effective sharing of knowledge between healthcare professionals and patients, and is an underexplored area. Objective: To understand how patients and healthcare professionals (HCPs) share and utilise knowledge in the social context of healthcare interactions within long term condition management. Methods: Thematic analysis of 93 hours of observations of healthcare interactions and 33 semi-structured interviews involving patients, carers and HCPs. Results: 3 themes were identified: normative social roles, differing professional roles and the value of knowledge. Knowledge sharing was a complex process heavily influenced by social and cultural norms within the healthcare context. Not all knowledge was easily shared within routine healthcare interactions. Discussion: The social context in which healthcare is practiced influences what knowledge is shared and how this is achieved. It favours sharing of clinical knowledge from HCPs to patients, and disadvantages patients in their ability to share their unique knowledge based on lived experience of illness. The opportunities for patients to be supported in their knowledge, skills and confidence within routine healthcare interactions is limited. Conclusion: Both patients and HCPs need support to recognise the characteristics of the social context of healthcare and their understandings of their roles within this in order for them to move beyond accepted behaviours to develop more effective partnership working. Patient or Public Contribution-patients were involved in initial design of the study, particularly ethics of ethnographic observation