As long-term, chronic conditions comprise an increasingly large share of illness in the UK and globally, healthcare providers and policymakers must rely more heavily on patients assuming a larger role in their own care through self-management. Self-management is critical both in terms of patient safety and patient experience.
While self-management programs are common, there is a lack of clarity around several issues:
• What should patients be expected to do for themselves?
o Are they capable of doing these things?
o If not, can they be taught?
o Should all patients achieve the same level of self-management ability?
o If not, how should variation be accounted for and/or addressed?
• Do self-management programmes teach those skills?
o What effects do they have?
o Can they be used to promote self-management behaviours?
o Which outcomes are of primary importance?
• Which aspects of disease management should remain the purview of healthcare professionals? Have these been clearly communicated to all sides?

Using chronic respiratory disease as a case study, this thesis addresses these gaps in understanding through a mixed-methods study of self-management capabilities and behaviours. Using secondary analysis of published literature and routine health record data, it conceptualises self-management ability as distinct from patient activation or engagement. It finds that specifying and measuring self-management is key to any attempt to ‘empower’ patients to change their behaviour, and also to adequately evaluate such an endeavour.
It then turns to the question of specifying and measuring self-management ability in respiratory diseases. Views of patients, clinicians, and policymakers were solicited through semi-structured interviews and online Delphi questionnaires, to derive an assessment tool to measure self-management ability for bronchiectasis.
This work culminates in a blueprint for a comprehensive self-management programme, called the Patient Academy, to deliver self-management education and skills training tailored to the needs and abilities of individual patients.