Toward Consensus on Self-Management Support: the International Chronic Condition Self-Management Support Framework

Mills SL, Brady TJ, Jayanthan J, Ziabakhsh S, Sargious PM
Source: Health Promot Int
Publication Year: 2017
Patient Need Addressed: Care Coordination/Management, Chronic Conditions
Population Focus: Vulnerable/disadvantaged
Intervention Type: Best practices
Type of Literature: White

Self-management support (SMS) initiatives have been hampered by insufficient attention to underserved and disadvantaged populations, a lack of integration between health, personal and social domains, over emphasis on individual responsibility and insufficient attention to ethical issues. This paper describes a SMS framework that provides guidance in developing comprehensive and coordinated approaches to SMS that may address these gaps and provides direction for decision makers in developing and implementing SMS initiatives in key areas at local levels. The framework was developed by researchers, policy-makers, practitioners and consumers from 5 English-speaking countries and reviewed by 203 individuals in 16 countries using an e-survey process. While developments in SMS will inevitably reflect local and regional contexts and needs, the strategic framework provides an emerging consensus on how we need to move SMS conceptualization, planning and development forward. The framework provides definitions of self-management (SM) and SMS, a collective vision, eight guiding principles and seven strategic directions. The framework combines important and relevant SM issues into a strategic document that provides potential value to the SMS field by helping decision-makers plan SMS initiatives that reflect local and regional needs and by catalyzing and expanding our thinking about the SMS field in relation to system thinking; shared responsibility; health equity and ethical issues. The framework was developed with the understanding that our knowledge and experience of SMS is continually evolving and that it should be modified and adapted as more evidence is available, and approaches in SMS advance.

Insights Results

Overview of article

  • This paper introduces 8 guiding principles and 7 strategic directions to provide direction for policy-makers and other implementers to enact comprehensive and coordinated approaches to self-management support (SMS). Together, the principles and strategic directions serve as the bulk of the framework
  • The purpose of the International Framework for Chronic Condition Self-Management Support is to help stakeholders (policy-makers, healthcare professionals, local decision makers, service providers, chronic condition-related organizations, consumer advocates, researchers and healthcare payers) in a variety of sectors influence policy, practice and research developments related to SMS for chronic conditions. It aims to promote the development and evaluation of effective interventions and support mechanisms that consider and value the diverse ways people adapt to and live with chronic conditions and encourage integration of these SMS initiatives into health, social and community settings

Methods of article

  • The framework development process began with an intensive 3-day roundtable discussion among 23 subject-matter experts from 5 English-speaking countries to share knowledge, discuss gaps in SMS and propose future directions
  • A thematic analysis of meeting transcripts was used to create an initial draft framework. It was then reviewed and refined with roundtable participants to build consensus on the framework’s definitions, guiding principles, vision and strategic directions. To validate the roundtable participant framework, the research team engaged in a broader international stakeholder consultation via an e-survey process that resulted in feedback on the framework from 203 individuals in 16 countries
  • Results from the international stakeholder e-consultation demonstrated very high levels of agreement for all content of the SMS framework


  • The 8 guiding principles are: 1) Informed by evidence and evolve in response to the needs of the chronic condition population; 2) Centered on the person or family and reflect the differing goals, needs and preferences of individuals and their differing social contexts; 3) Focused on improving an individual’s capacity to be healthy and live well according to their values; 4) Created to be equally available, appropriate and accessible to all persons with chronic conditions; 5) Developed to promote benefits and minimize potential harms; 6) Implemented in ways that respect an individual’s choice, autonomy and rights to determine their own goals and participation in SMS; 7) Embedded in the management and treatment of chronic conditions; and 8) Integrated across the continuum of health and community services from prevention to palliative care
  • The 7 strategic directions are: 1) Support people with chronic conditions and their families to be meaningfully engaged in decision-making, planning and evaluation of SMS initiatives; 2) Expand reach and range of, and access to, SMS interventions, programs and services in healthcare systems and communities; 3) Advance evidence on the effectiveness and appropriateness of SMS interventions and other kinds of SMS-related initiatives; 4) Improve quality of SMS services, programs and interventions; 5) Forge and strengthen linkages within and between sectors, policies, programs and service providers; 6) Foster leadership, commitment and accountability for SMS at all levels of healthcare and social and community services; and 7) Build infrastructure to support SMS initiatives and provide resources and funding to support these initiatives

Key takeaways/implications

  • 4 key directions in future thinking of SMS includes 1) System thinking; 2) Shared responsibility; 3) Health equity; and 4) Ethical dimensions
  • The operationalization of the framework may be limited by existing fragmentation within health systems and weak leadership and commitment from facilitators