Behaviour Change and Social Blinkers? The Role of Sociology in Trials of Self-Management Behaviour in Chronic Conditions

This chapter argues for modifications to both trial design and interventions to change behaviour that make constructive use of the concept of social context. It starts by outlining the policy drivers for self-management approaches, followed by discussing some behaviour change models underpinning self-management approaches that inform current UK health policy, and examine their implications for change in patients and healthcare professionals. The chapter discusses the use of trials to amass evidence about the effectiveness of interventions. Two examples of theory-based self-management trials for chronic conditions are presented. These highlight the complex nature of self-management and the necessity of better integrating the social into behaviour change models. The discussion of the policy drivers, the contextualisation of behaviour change approaches and the responsive trial design used in whole system informing self-management engagement (WISE) and management of osteoarthritis in consultations study (MOSAICS) points to a way forward to produce effective interventions for self-management.