develop health care self-management skills including illness-specific competencies and
generic decision-making skills. Evaluations of these interventions have found that they
can be both effective in changing behaviour and also cost-effective. For example, Lorig,
Mazonson and Holman (1993) found that a self-management course for patients with
chronic arthritis resulted in increased self-efficacy, reduced pain and produced a 43
per cent reduction in consultations with doctors. The course was delivered to groups
by trained volunteers who were themselves arthritis sufferers. For patients suffering
from rheumatoid arthritis, the reduction in health service usage constituted a saving
of $162 per patient. Since there are about 386,600 people with rheumatoid arthritis
in the UK (Symmons et al., 2002), then, even using 1993 figures with current currency
conversion rates, this intervention has the potential to save the UK National Health
Service £32 million if it were provided for all sufferers. Other evaluations have
identified a variety of health care gains from participation in such group-based self-
management training. Barlow et al. (2002) reviewed 145 evaluations and concluded
that self-management training led to increases in patients’ knowledge and SE, better
symptom management, adoption of appropriate coping techniques and enhancements
in health status. Other studies have found reduced hospitalization (e.g. Lorig et al.,
1999a) and enhanced physical and psychological well-being following attendance at
such courses (Wright et al., 2003).
Evaluation of health interventions of this kind illustrates one area in which quantita -
tive and qualitative research complement each other (see also Chapter 10). Quantitative
research is required to assess effectiveness in terms of predefined criteria from health
care usage figures, through to attitudes and quality of life using previously validated
measures. However, qualitative research, usually using interviews or focus groups (where
a group discusses a series of questions), can examine the perspective of the individual
user in detail (Payne, 2004). Here the focus is not on the significance of mean differences
but on detailed similarities and differences between users’ accounts of the intervention.
Such research might, for example, reveal which intervention techniques were especially
valued or disliked by users and also highlight the range of individual responses in terms
of cognition, emotions and behaviour. This could help intervention designers
understand why some users respond positively and others negatively and imply
modifications to the delivery or content of an intervention. Qualitative analysis of
interview data could also reveal positive or negative experiences not previously
considered by researchers and, thereby, imply new theoretical advances and/or new
outcomes. For example, an intervention targeting motivation change might be found
to work for many people through new social relationships and changes in identity.
Researchers regularly judge the methodological adequacy of quantitative studies but
this is more challenging in the case of qualitative studies. An interesting guide to judging
the quality of qualitative studies relevant to health care has been proposed by Daly et
al. (2007). For a useful introduction see Payne (2004) and for further details on qualitative
theory and methods see Murray and Chamberlain (1999) and Smith (2003).
Influenced by the results of quantitative and qualitative evaluation research, the UK
Department of Health began to develop the Expert Patient Programme (EPP) in 2001.
This is a generic self-management training intervention designed to empower patients
to effectively manage chronic health conditions and associated symptoms (see Chapter
10). The longer-term aim of the EPP was to facilitate patients becoming key decision-
makers in the treatment process and gaining greater control over their lives through
184 MOTIVATION AND BEHAVIOUR