Table 3 Study authors’ reflections and lessons learned

Practical lessons from the authors’ reflections on the process of implementing complex self-management support interventions in routine clinical care.

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Effective patient self-management education needs to be supported by regular reviews [31, 37, 44], underpinning a partnership with patients [37]. In addition to education, aligning with patients’ perceived needs [35, 40] and preferences [32, 35].

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Only a proportion of people accept the offer of self-management education, and all studies reported an attrition rate. For many interventions, especially those delivered in deprived communities, recruiting and retaining patients was a major challenge [37, 38]. Financial incentives (free access to care, free prescriptions, favourable insurance premiums, free patient resources) were potential strategies for increasing engagement [31, 37, 38, 43–45].

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The use of telephone interventions may overcome some of the practical barriers to participation in self-management programmes [32, 35, 36, 41].

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Achieving change is a challenge, even in well-motivated teams [30]. There is a need to support professionals as they integrate new behaviour into practice [39]. Promising approaches include collaboratives, and plan/do/study/act (PDSA) cycles [30, 36], and introduction of self-management support as a component of improved chronic care [31, 43–46].

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There is a need for regular oversight and frequent reviews to ensure intervention fidelity and respond to evolving situations [45]. Frequent staff turnover can be a particular challenge which needs to be addressed [30, 34], to ensure that skills are not lost.

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Professional training in supporting self-management [36, 37, 45, 46], collaborative multidisciplinary working [36, 45], with good communication and referral systems between professionals [44], and involving existing staff members in the design and implementation of interventions [33, 36, 42] are potentially important ingredients of implementing self-management support.

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A team approach involving the community (and schools) was seen as essential to the success of projects in deprived, minority communities [34, 37, 47].

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A key facilitator highlighted by several authors is the commitment of the healthcare system [41, 43–46] and/or local practice or clinic [36, 41, 42], with on-going evaluation [44–46].

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There are practical barriers if on-going funding or resources (including time) are insufficient to enable complex interventions to be sustained [30, 36, 38].

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Technological solutions (such as computerised cognitive behaviour therapy programmes, automated telephone calls) are being explored and show some promise [35].