Partnering in primary care in New Zealand: Clients' and nurses' experience of the Flinders Program in the management of long-term conditions

Abstract

Aim and Objectives: To explore clients’ and nurses’ experience of the Flinders Program™ of self-management within a study assessing the feasibility for a trial gauging the effectiveness of the Flinders Program™ in New Zealand (NZ). Background: The Flinders Program™ has been adopted in NZ as a useful and appropriate approach for improving long-term condition management; approximately 500 health professionals have been trained in its use. Evidence for the effectiveness of self-management is inconclusive and support for introduction of new and complex interventions in primary care inconsistent. Design: The feasibility study used mixed methods with simultaneous qualitative and quantitative components including a web-based survey. The qualitative component, reported in this paper, used interpretive description. Method: In 2009, two focus groups were conducted with nurses participating in the intervention group of the feasibility study together with interviews with 11 clients with long-term conditions who had completed Flinders’ assessments and four nurses who partnered with these clients. Free-text responses from survey participants (n=355) who had completed ‘Flinders’ training in NZ since 2005 were included in the interpretative analysis. Findings: Three theme describe the experience of clients and nurses: ‘enablers and benefits’ with the sub-themes of process, relationships and time; ‘challenges’ with the sub-themes of motivation, resistance to change, primary care structure, and time. ‘A catalyst for change’ is the third theme. Conclusion: While implementation of the Flinders Program™ in NZ is limited, there are benefits of the approach for clients and nurses in terms of greater understanding of self-management, collaborative care and effective strategies to support client behaviour change. There are however challenges in facilitating such programs in primary care. Relevance to clinical practice. Understanding the experience of the Flinders Program™ in primary care illustrates the value of supported self-management for clients with long-term conditions, while highlighting the challenges of implementing new and complex interventions.