Abstract Aim: To gain insight into the relationship between self-management abilities (taking initiatives, investment behaviour, variety, multifunctionality, self-efficacy, positive frame of mind) and physical, psychological and social frailty. Design: A cross-sectional study. Methods: 145 community-dwelling older people receiving home-care completed a questionnaire on sociodemographic factors, the Self-Management-Ability-Scale and the Tilburg Frailty Indicator. After determining correlations, sequential multiple linear regression analyses were executed. Results: All self-management abilities are negatively associated with physical frailty; five (except multifunctionality) are negatively associated with psychological frailty. Variety in resources and positive frame of mind are negatively associated with social frailty. Sociodemographic characteristics, chronic diseases and self-management abilities together significantly explain participants’physical (34.9%), psychological (21.4%) and social (43.9%) frailty. After controlling for sociodemographic characteristics and chronic diseases, the self-management abilities together significantly explain 11 per cent of psychological and 6.8 per cent of social frailty. Having a positive frame of mind significantly negatively influences social frailty.
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Background: There is an increasing number of patients with a chronic illness demanding primary care services. This demands for effective self-management support, including collaborative goal setting. Despite the fact that primary care professionals seem to have difficulties implementing goal setting, little information is available about the factors influencing the complexity of this process in primary care. Objective: The aim of this study was to contribute to an understanding of the complexity of selfmanagement goal setting in primary care by exploring experts’ and primary care professionals’ experiences with self-management goal setting and viewpoints regarding influencing factors. Methods: A descriptive qualitative research methodology was adopted. Two focus groups and three individual interviews were conducted (total participants n = 17). Thematic content analysis was used to analyse the data. Results: The findings were categorized into four main themes with subordinated subthemes. The themes focus around the complexity of setting non-medical goals and around professionals’ skills and attitudes to negotiate and decide about goals with patients. Furthermore, patients’ skills and attitudes for goal setting and the integration of goal setting in the time available were formulated as themes. Conclusions: Setting self-management goals in primary care, especially in family medicine, might require a shift from a medical perspective to a biopsychosocial perspective, with an increasing role set aside for the professional to coach the patient in expressing his self-management goals and to take responsibility for these goals.
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Purpose: Self-managed institutional homeless programmes started as an alternative to regular shelters. Using institutional theory as a lens, we aim to explore the experiences of stakeholders with the institutional aspects of a self-managed programs.Method: The data we analysed (56 interviews, both open and semi-structured) were generated in a longitudinal participatory case-study into JES, a self-managed homeless shelter. In our analysis we went back and forth between our empirical data and theory, using a combination of systematic coding and interpretation. Participants were involved in all stages of the research.Results: Our analysis revealed similarities between JES and regular shelters, stemming from institutional similarities. Participants shared space and facilities with sixteen people, which caused an ongoing discussion on (enforcement of) rules. Participants loathed lack of private space. However, participants experienced freedom of choice over both their own life and management of JES and structures were experienced more fluid than in regular care. Somestructures also appeared stimulated self-management.Conclusion: Our analysis showed how an institutional context influences self-management and suggested opportunities for introducing freedom and fluidity in institutional care.
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