Lay-led self-management in chronic illness: a review of the evidence

Objectives: In this paper, we seek to clarify what is known about self-care in chronic illness and the impact of lay-led self-management programmes. The main focus of the paper is the specific 'lay-led' interventions developed by Kate Lorig and her collaborators in the USA, and in the context of the English Expert Patients Programme (EPP). Methods: A systematic search of relevant databases was undertaken. Results: Seventeen articles and two conference papers met the criteria set. These papers documented the use of condition-specific lay-led self-management programmes and generic lay-led self-management programmes. Discussion: Despite the potential benefits of enhanced self-management, the review of the literature presented here suggests several possible problems associated with the presentation and implementation of initiatives such as the EPP programme. These include the possibility that advocates of public service improvements have on occasion been tempted to overstate the evidence for the relative and absolute effectiveness of lay-led self-management programmes. In addition, the varied experiences of those living with a chronic illness warn against promulgating rigid prescriptions about what patients-should think and do. The evidence to date is indicative of short-term benefits being derived from the provision of lay-led self-management programmes.