Self-management education for patients with chronic diseases in South Africa : educational approaches and conditions for effective implementation

Despite the high need for self-management education (SME) for chronic diseases in developing countries, existing programmes have almost exclusively been developed and evaluated in developed countries. This thesis looks at the feasibility of a more context-specific approach to chronic disease SME in resource-limited settings by investigating the needs for SME in a developing country (South Africa), developing a SME tool that meets these needs, and testing the conditions for its successful implementation. The thesis consists of a series of research papers investigating the current status of diabetes SME in developing countries, the characteristics of existing SME programs in South Africa, the perceived needs for self-management among chronic patients and experts, and the feasibility of a contextually adapted SME tool for diabetes and hypertension in the form of a care-plan booklet. A pilot study of the use of this tool showed positive changes in hypertension knowledge and served as a basis for a larger effect study protocol. By adding to the knowledge on chronic disease SME in resource-limited settings this thesis can inform decision-makers to help integrate self-management into routine care.