Patient-provider perspectives on self-management support and patient empowerment in chronic care: A mixed-methods study in a rural sub-Saharan setting.
Vibian Angwenyi, Carolien Aantjes, Joske Bunders-Aelen and 2 others
PMID 31225662WHAT IT FOUND
Chronic patients in rural Malawi reported increased walking, but many did not discuss their records or learn where to access unavailable services.
Key findings
01Many patients reported not discussing information in patient-held records or receiving guidance on where to access unavailable services.
02Self-reported walking time increased from 57.9 min/week at baseline to 86.6 min/week and 91.3 min/week at later survey rounds.
03Patients said crowded clinics, long queues and provider attitudes limited their openness to ask questions or seek clarification.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study described usual community home-based care rather than assigning patients to a tested intervention, so it cannot show that any component caused improvement. The survey relied on patients' self-reported exercise, diet and health checks. Patients were recruited from community home-based care programmes, so the findings may not apply to chronic patients receiving standard clinic care. The HIV and non-HIV survey groups were unequal (102 HIV vs 38 non-HIV), and HIV services were better resourced than general chronic care. Survey participation fell from 140 at baseline to 126 at month twelve. Qualitative findings came from small purposive samples in one rural district, so transferability is limited. Patient empowerment and self-management measures were adapted from western settings and were not fully validated in this context.
Declared interests
The authors declare that they have no competing interests.
The easy way to misread this
Do not read the increases in self-reported walking as proof that community home-based care improved self-management. Patients were not assigned to a tested intervention, and they received usual support from CBO/FBO volunteers, family caregivers, expert patients, peer groups and clinic providers, so the contribution of any single component cannot be separated.