Chronic physical illness: self-management and behavioural interventions
International Journal of Integrated Care, 11 March 2009 - ISSN 1568-4156
Book review
Chronic physical illness: self-management and behavioural interventions
Stan Newman, Liz Steed, Kathleen Mulligan
Maidenhead: Open University Press/McGraw Hill, 2009, pp 310,
ISBN 978 0 335 21786 1
Sharon Lawn, Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, Australia

Health care systems are complex. Managing chronic conditions is often complex and often involves multi-morbidity or multiple risk factors and complications once a person develops a chronic condition. These forces together make for a highly complex area that relies heavily on effective communication, engagement and skills of all involved within an integrated system. The reality is that there are often diverse views about who is the expert, and inter-disciplinary roles and rules that need to be worked out and agreed upon. There are structural impediments and challenges in creating a system of care where the client is asked their view, heard and fully understood and where they are not merely shuttled between fragmented service silos.

Writing a book in the emerging area that will meet the needs of all concerned and do justice to all perspectives is challenging. Newman, Steed and Mulligan have attempted to provide both a practical guide for health professionals to assist them in supporting health behaviour change in the people they serve, and address a number of the larger debates in this area.

The book is divided into 5 distinct parts beginning with a clear and interesting introduction to the issues and implications of demographic and social changes that have brought traditional approaches to chronic disease management into question, not least, the growing burden posed by ageing populations.

Part two includes a range of chapters that aim to in-crease the reader’s understanding of self-management support. Underpinning theoretical models for behaviour change are outlined, as are common modes of delivering self-management support. Much of the content is targeted to the individual health professional and their practice with little reference to the influence of larger organizational systems in which they work. The internationally recognized Chronic Care Model developed in the United States receives only a scant mention in Chapter Five. Part three provides two interesting chapters that successfully argue for the need to fully evaluate the outcomes. The reader may feel that they sit out of sync with the other parts of this book which attempts to meet the needs of many (students, health professionals in the field, managers and researchers) without clearer defining upfront who the book is for.

Part four provides a collection of distinct chapters, each focusing on specific physical health conditions. Early career health professionals and students will find this section useful as a general guide to the distinct needs of clients with each condition from a clinical perspective. Little attempt is made to look at what needs are common across these various conditions or to discuss the reality of often co-morbid health conditions experienced by clients.

Part five provides a very brief discussion of the integration of self-management support into routine care. Readers looking for comprehensive information about organizational change and systems change with respect to chronic condition self-management will be disappointed. However, this is clearly not the intent or focus of this book and indeed would warrant its own dedicated space as a separate resource.

What is good?

Newman, Steed and Mulligan have provided an honest attempt to capture the essential practical material required for those working directly with clients in this growing area. As an introductory text, it achieves its goal.

What could be better?

The editors have brought together several important ideas pertinent to this field of health service. However, there are a number of equally important areas that appear to have been overlooked as part of a more comprehensive understanding that such a book could provide. The first of these is that the book speaks to health professionals largely from a clinical perspective rather than a more holistic psychosocial perspective that acknowledges the person with the chronic condition’s perspective in the presumed partnership in care. A discussion of the implications of social determinants of health on the management of chronic illness is absent and no attempt is made to explain why mental health and wellbeing has not been incorporated, despite it being a common complication and central to the successful self-management of many chronic conditions. These are areas where workers in the field would value support and advice.

Prevention, risk factors and managing complications generally are not addressed (except for example in Chapter 11) and each chronic physical health condition discussed is viewed largely in isolation. Systemic issues and the value assumptions that health professionals often bring to their interactions with clients could be further discussed. Not until we have serious debate about such issues will health services fully translate the current rhetoric of collaborative partnership into reality for health professionals and the clients they serve.

As a broad introductory text, this book achieves its purpose. It marks the beginning of what will likely be several worthwhile efforts to comprehensively build the debate and understanding of the complexities of the field of chronic condition self-management support implementation into practice.