Engagement in group-based self-management support programmes for people living with long-term conditions: a realist evaluation

Golder, Elena (2025) Engagement in group-based self-management support programmes for people living with long-term conditions: a realist evaluation. Doctoral thesis, Plymouth Marjon University.

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Abstract

Group-based self-management support (SMS) interventions are advocated to help individuals to manage long-term health conditions, which are a growing health concern. Engagement with group-based SMS programmes is a frequently cited challenge to programme success yet the concept is often ill-defined and focuses on individual states and behaviours. A realist evaluation, a type of theory-driven evaluation, was adopted to generate explanatory theory of how engagement occurs in group-based SMS programmes. Programme theories, which explain how informal and formal elements of interventions work, were developed and tested using a suite of person-centred health and wellbeing programmes provided by a university in partnership with local healthcare organisations in the Southwest of England. Programme theories were developed using realist interviews with programme architects and practitioners, historic patient feedback from programmes delivered by the health and wellbeing (H&W) team, and data from a concurrent study. Programme theories were refined and verified using a multi-case study design which adopted non-participant observations of three types of group�based SMS programmes, and realist interviews with programme practitioners and participants. The three programmes were a Back Wellbeing Programme, a Living Well With and Beyond Cancer Programme, both of which were delivered at the university campus, and a Leg Wellbeing Programme, which was delivered at the university campus and three other sites in and around the city. The output of this realist evaluation comprises a conceptual framework for engagement in group-based SMS programmes within which seven programme theories explain how various aspects of programme architecture impact engagement, for whom, in which circumstances and why. The choice afforded to participants when participating in programmes, feedback and differentiation of activities, the emotional and physical environment, informal space for connection and time to develop relationships, helping individuals to identify how programmes may support their individual needs, the active involvement of students in programme delivery, and co�constructed engagement between practitioners and participants were all identified to support engagement in programmes. Key contexts influencing these mechanisms and their outcomes were also identified. The generation and empirical confirmation of these programme theories support a wider argument for expanding the focus of engagement beyond individuals and to shift away from viewing non-engagement as a patient problem, which has dominated the literature to date. The portable theories presented in this work can be used to guide the support and evaluation of engagement in group-based SMS programmes and offer a platform for further testing and refinement of engagement theory in similar programmes in different contexts. Further, the theories may be used to inform programme design and support the training of practitioners delivering group-based SMS programmes to improve the success of these complex interventions.

Item Type:	Thesis (Doctoral)
Depositing User:	Ms Raisa Burton
Date Deposited:	27 Aug 2025 14:51
Last Modified:	27 Aug 2025 14:51
URI:	https://marjon.repository.guildhe.ac.uk/id/eprint/18023

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