Bishop, J.

Kosmala-Anderson, Joanna H.

Turner, Andrew P.

Wallace, Louise M.

Coventry University Pure Portal

 Coventry University    Coventry University Repository for the Virtual Environment (CURVE)  Author names: Kosmala-Anderson, J.H. , Wallace, L.M. , Turner, A. and Bishop, J  Title:  UK clinicians’ motivation towards using self management support practices when working with patients with long term conditions Article & version: Powerpoint presentation slides Original citation & hyperlink:  Kosmala-Anderson, J.H. , Wallace, L.M. , Turner, A. and Bishop, J. (2010, June). UK clinicians’ motivation towards using self management support practices when working with patients with long term conditions. Presented at the Joint HSRN and SDO Network Annual Conference: Delivering Better Health Services, 2 & 3 June, Manchester, UK. http://www.sdo.nihr.ac.uk/sdoconferencenews.html   Copyright © and Moral Rights are retained by the author(s) and/ or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This item cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder(s). The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders.  Available in the CURVE Research Collection: March 2012    http://curve.coventry.ac.uk/open  UK CLINICIANS’ MOTIVATION TOWARDS USING SELF MANAGEMENT SUPPORT PRACTICES WHEN WORKING WITH PATIENTS WITH LONG TERM CONDITIONS  Dr. Joanna Anderson Prof. Louise M Wallace Dr. Andy Turner Ms. Alex Bishop  Co Productive Consultation skills  To enable clinicians to support patients to self manage we need to identify the  behavioral skills required, and  the personal and organisational factors supporting their use:  Review show similar  features of effective consultation skills derive from theories of behaviour change-(Social cognitive theory, Trans theoretical change, motivational interviewing):  Effective consultations’ features: (1) Allow and encourage the patient to define their health problems and purpose of consultation (2) Explore options for dealing with these problems (3) Offer the patient choice and respect the choice when it is made;  (4) The clinician retaining responsibility for technical knowledge but sharing the meaning and possible utility of that expertise with the patient  Behavior change processes  for Long Term Conditions (Wagner et al, 2001):  (1)  Joint Agenda Setting (2)  Problem Solving  (3)  Collaborative Goal Setting (4)  Goal Follow Up     Chronic care model The Health Foundation's Co-Creating Health (CCH) is aiming to demonstrate health Benefits for people with long term conditions through promoting self management by patients, supported by clinicians and their health services.      RESEARCH QUESTIONS    (Q1) What personal and organisational conditions motivate clinicians to support  self management for long term conditions?  (Q2)How does motivation towards self management practice  predict clinician’s reported use of specific self management practices?  (Q3) What psychological factors predict the effectiveness of training in self management support practices?   Theoretical model-Self Determination Theory (Ryan and Deci, 2000)     THE SELF DETERMINATION THEORY  (Deci & Ryan, 1985)  Autonomy Relatedness Competence Intrinsic Extrinsic Amotivation Integrated Identified Introjected External PSYCHOLOGICAL  NEEDS MOTIVATIONAL  REGULATIONS OUTCOMES Behaviours Cognitions Affect Satisfied Positive Negative Thwarted INTERNALISING BEHAVIOURS   EXTRINSICALLY MOTIVATED BEHAVIOUR  Autonomy support: providing choice and meaningful rationale, minimizing demands  Structure: setting goals, making expectations clear and providing feedback  Interpersonal Involvement: dedicating psychological resources, such as time, energy, and affection (similar to social support)   Autonomy supportive environment  Feeling of competence in performing the activity (positive feedback)   Need of relatedness - the behaviour is valued by the group INTRINSICALLY/INTERNALY MOTIVATED BEHAVIOUR  Measures  Practices in Self Management Support questionnaire (PSMS):  self  report measure , 25 items in 3  subscales: Clinical Self Management Support,  Patient  Centeredness and Organisation of Services to Support Self Management.   Basic Psychological Needs Scale: adapted from previous SDT research protocols; 8  Items   regarding clinicians’ competence in providing SMS, the reasons they  provide SMS  (autonomy scale), and the support they receive from their colleagues for these activities (relatedness scale).   Motivational Regulation to Support Self Management Questionnaire: adapted from the Self-Regulation Questionnaire developed from previous SDT research; measures how strong is each type of motivation (from intrinsic to external plus  amotivation) to support SM for LTC.   METHOD CROSS SECTIONAL STUDY:  surveying clinicians from demonstrations sites  in the pathway  of care for four target long term conditions-who have NOT volunteered for training.   LONGITUDINAL COHORT DESIGN:  pre and post training surveys  of clinicians who volunteered to attend professional  training addressing principles and practice of SMS  INCLUSION CRITERIA: clinicians working with patients who had the chosen long term condition of  8 healthcare economies (20 trusts)-  diabetes, depression, musculo-skeletal pain or COPD. CHARACTERISTICS OF THE SAMPLES SAMPLE GENDER PROFESSION CARE TYPE TRAINING  Male Female Doctor Nurse Allied Psych Primary Sec Both Yes No CS 109 22.8% 369 77.2% 118 30.1% 163 42.5% 66 17.2% 13 3.3% 187 53.2% 132 37.6% 27 7.7% 264 55.2% 50 43.8% LS 34 30.3% 78 69.6% 39 40.1% 35 36.1% 14 14.4% 6 6.2% 55 59.8% 30 32.6% 6 6.5% 62 44.8% 64 56.1% SAMPLE  SEND OUT RECEIVED  RESPONSE RATE CS 951 482 51% LS 286 114 40% Q1: What personal and organisational factors motivate clinicians to support self management?  (CS & LS baseline data; N=596)        PREDICATORS CLINICAL SMS PATIENT CENTEREDNESS ORGANISATIONAL SMS   Satisfaction of the basic needs Autonomy β coefficient=0.15; p<.0001 No effect No effect  Competence β coefficient=0.21; p<.0001 β coefficient=0.20; p<.0001 β coefficient=0.20; p<.0001 Relatedness No effect No effect No effect   Autonomous motivation to support self management Intrinsic β coefficient=0.15; p=.01 No effect  β coefficient=0.14; p=.01 Integrated β coefficient=0.23; p<.0001 No effect  β coefficient=0.13; p=.04 Identified β coefficient=0.14; p=.03 No effect  No effect  Previous training in SMS β coefficient=0.27; p=.0001 β coefficient=0.12; p=.01 β coefficient=0.25; p<.0001 Intensity of work with LTC No effect β coefficient=0.09; p=.03 β coefficient=0.08; p=.02 High levels of satisfaction of competence and previous training in SMS predicts that clinicians will report practicing SMS in all three areas. Internalized regulation to support SMS is associated with engagement in Clinical and Organisational SMS. Clinicians who spend more time working with LTC are more likely to engage in Organisational SMS and patient centered practices.  Q2: Can personal conditions predicting engagement in self management support  be influenced by training in SMS?  (LS data pre & post training)   CHANGES PRE & POST TRAINING PRE ADP POST ADP PAIRED T TEST m SD m SD t df p CLINICAL SMS (0-7 scale     better)  4.78 1.41 5.09 1.05 -2.7 108 .01 PATIENT CENTEREDNESS  (0-7 scale      better) 5.37 1.33 5.67 1.22 2.4 108 .02 ORGANISATIONAL SMS  (0-7 scale     better)  3.59 1.50 3.78 1.29 -1.0 108 NS AUTONOMY (0-7 scale    better)  4.95 1.04 5.27 1.16 2.7 70 .02 COMPETENCE (0-7 scale     better)  4.31 1.26 5.03 1.05 5.7 70 .001 RELATEDNESS (0-7 scale     better) 4.30 1.51 4.61 1.43 -2.0 70 NS Completing the training significantly increases clinicians’ autonomy and  confidence to effectively support self management. As expected we observed an increased use of Clinical SMS and Patient Centeredness. We did not find any changes in using Organizational SMS, which is probably related to the low observed course content in this area.  Q3: What factors predict the effectiveness of training in self management support? (LS data pre & post training) PREDICTORS CLINICAL SMS PATIENT CENTEREDNESS ORGANISATIONAL SMS  Pre training satisfaction of the basic needs Autonomy  Interactive effect: β coefficient=36.7; p=.02 No effect  Interactive effect: β coefficient=31.4; p=.03 Competence No effect Relatedness No effect Pre training autonomous motivation to support self management Intrinsic β coefficient=0.31; p=.03 β coefficient=0.41; p=.02 No effect Integrated No effect No effect No effect Identified No effect No effect No effect  Post training satisfaction of the basic needs Autonomy No effect  Interactive effect:   β coefficient=7.02; p=.007  Interactive effect:  β coefficient=7.96; p=.01 Competence No effect Relatedness No effect Previous training in SMS β coefficient=0.231; p=.01 No effect No effect Intensity of work with LTC No effect No effect No effect Pre training satisfaction of the three psychological needs was good predictor using Clinical and Organizational SMS practices post training. Strong intrinsic motivation to SMS before training predicted increased using of Clinical SMS and patient centered practices after completing the training. Post training satisfaction of the three basic needs predicted using patient centered practices and Organizational SMS after completing the training. SUMMARY OF FINDINGS-1 (Q1) That the most important factors determining whether clinicians practice self management support for patients with LTCs are:  Feelings of competence in relation to SMS,   Autonomy to engage in SMS,   Internalized regulation to support SM   Previous training in SMS  High intensity of work with patients with LTC   SUMMARY OF FINDINGS 2  (Q2) Professional training addressing principles and  practice of SMS effectively increase:  Clinicians' feeling of competence in relation to SMS  Autonomy to engage in SMS  Using Clinical SMS and patient centered practices  (Q3 )The most important predictors of post training engagement in self management support practices are:  satisfaction of basic psychological needs in relation to self management support both before and after the training.  CONCLUSIONS AND PRACTICAL IMPLICATIONS 1  • Feeling of confidence to effectively support self management, freedom to chose the most appropriate way to support patients to self manage and strong internalised motivation to support self management are the most important factors determining using SMS practices by clinicians working with patients with LTC.  •  Clinicians who previously attended training in SMS and spend more time at work with patients with LTC are also more likely to use SMS practices, perhaps because they have had an opportunity to acquire SMS skills and have a chance to practice them on regular basis.  • Skills based training in SMS was effective in increasing clinicians confidence to support SM and giving them autonomy to chose the optimal way to support their patients to self manage. It also increases self reported use in clinical practice.     CONCLUSIONS AND PRACTICAL IMPLICATIONS -2  • To ensure the positive training outcomes are sustained  it is important to create supportive work environment and ensure clinicians have an opportunity to regularly practice and improve their SMS skills to maintain high level of confidence.   • Testing the skills in practice (e.g. by analysis of video taped consultations) is needed to both verify the self reported use, and more importantly, to offer feedback to clinicians that will build competence and sustain motivation..   

UK clinicians’ motivation towards using self management support practices when working with patients with long term conditions.

https://pure.coventry.ac.uk/ws/files/4056984/UK%20clinicians%20motivation.pdf

UK clinicians’ motivation towards using self management support practices when working with patients with long term conditions.

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