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Long Term Conditions Collaborative: Making the Connections - Food For Thought



There are a number of ways to identify and stratify populations according to the level of complexity, dependency or risk. However it does not follow that those at highest risk, people with the most complex needs or those with the most to gain from interventions will be the people who are most willing or ready to engage with services. We must recognise this to ensure we engage the people who most need to be reached. To reach and engage with people, we must ask what is it that really matters to them in terms of their health and its place in the context of their personal, family, work, financial, social and leisure priorities.

Although a target population may have in common factors such as having a long term condition or risk factors for that condition, there will generally be large differences across the cohort regarding attitudes towards health and perceived value of the preventative or support services on offer.

The Keep Well target population is an example of a heterogeneous group, even when drawn from the most socially deprived areas and all within socioeconomic groups D & E. Research suggests the Keep Well target population can be segmented broadly into three groups based on their attitudes towards health and the perceived value of services on offer. These three groups can be described as health involved, healthy enough and health wary and are characterised as:

Health Involved

Convinced of effort required to stay/be healthy, see service as a means of maintaining good health, see few barriers of any kind to involvement, often have a 'reason' to be healthy. Will be early adopters of services.

Barriers to involvement, whilst minimal, are most likely to be practical in nature, e.g. appointment times or economic constraints - unable to afford bus fares, child care costs or leisure facility entrance fees.

Healthy Enough

A direct link between maintaining good health and an improved life is not clear to the person - other life issues have priority, feel sufficiently healthy so that no extra effort is urgently required, expect they will get a warning of health risk and act then.

Barriers to involvement could be practical, however, tackling rational and emotional barriers, e.g. other priorities or feelings of embarrassment, are most likely to lead to greater involvement.

Health Wary

Often have a significant emotional barrier to engaging with the service. This might be a fear of finding something they will be unable to deal with. Through previous experiences may feel unconvinced about what a service can do for them. There may be an aversion to visiting a GP/health professional for a variety of reasons, e.g. embarrassment, scepticism.

Are most likely to have significant emotional barriers but there could be other factors needing addressed. Whilst all groups welcomed a respectful, non-judgmental tone engendering trust, this was felt to be especially important in this segment.

No single strategic approach will engage all segments equally. For successful engagement, the approach needs to be tailored to a number of factors:

  • Recognising the wider social context for the individual
  • Understanding emotional/rational readiness of the individual to engage with the service
  • Overcoming practical barriers to reach

Barriers and Potential Solutions

The following models outline solutions to address some of the practical, emotional and rational barriers found within the Keep Well population. These reinforce the important role that motivational interviewing, and related activities, have within training and development of staff supporting anticipatory care and self management.

Practical Barriers

Practical Barriers

Rational Barriers

Rational Barriers

Emotional Barriers

Emotional Barriers

Food For Thought:

  • How can these approaches be used or adapted to help you identify and engage people with long term conditions about self management information, advice, support and education?
  • How can this learning help you to design the supports people need to manage their condition?