Data from: Patient factors that influence decision-making in self-management support: a clinical vignette study

Background and aim: Self-management support is an integral part of current
chronic care guidelines. The success of self-management interventions
varies between individual patients, suggesting a need for tailored
self-management support. Understanding the role of patient factors in the
current decision making of health professionals can support future
tailoring of self-management interventions. The aim of this study is to
identify the relative importance of patient factors in health
professionals’ decision making regarding self-management support. Method:
A factorial survey was presented to primary care physicians and nurses.
The survey consisted of clinical vignettes (case descriptions), in which
11 patient factors were systematically varied. Each care provider received
a set of 12 vignettes. For each vignette, they decided whether they would
give this patient self-management support and whether they expected this
support to be successful. The associations between respondent decisions
and patient factors were explored using ordered logit regression. Results:
The survey was completed by 60 general practitioners and 80 nurses.
Self-management support was unlikely to be provided in a third of the
vignettes. The most important patient factor in the decision to provide
self-management support as well as in the expectation that self-management
support would be successful was motivation, followed by patient-provider
relationship and illness perception. Other factors, such as depression or
anxiety, education level, self-efficacy and social support, had a small
impact on decisions. Disease, disease severity, knowledge of disease, and
age were relatively unimportant factors. Conclusion: This is the first
study to explore the relative importance of patient factors in decision
making and the expectations regarding the provision of self-management
support to chronic disease patients. By far, the most important factor
considered was patient’s motivation; unmotivated patients were less likely
to receive self-management support. Future tailored interventions should
incorporate strategies to enhance motivation in unmotivated patients.
Furthermore, care providers should be better equipped to promote
motivational change in their patients.