PA24 A grounded theory analysis to explore the impact of group work as a method of service delivery by community matrons to support those living with multiple long-term conditions.

The role of the Community Matron was introduced in 2005 (DoH 2005a) to case-manage those patients deemed as very high intensity service users to prevent and reduce unscheduled admission to secondary care. Related studies on the effectiveness of managed care indicated the need to manage the demand of high service users who had multiple long-term conditions (LTCs). Little evidence exists as to how the role should be delivered to enhance disease self-management and levels of self-efficacy for the service users.Reviewing the role of Community Matrons in regard to their work with patients with multiple long-term conditions.This qualitative participatory action research study explored the use of group work as a method of Community Matron intervention. Drawing on the theoretical underpinnings of Bandura's Social Learning Theory (1997), a social learning framework approach was adopt ed. Twenty nine participants with multiple long-term conditions were recruited. Within each intervention group there were 8-10 participants, led by a Community Matron working in both the researcher and practitioner role.Three main categories emerged that highlighted the process by which community matrons support patient groups; 1) comparison leading to re-motivation of the self through comparing others, 2) learning leading to enhanced self-management techniques through storytelling and understanding of each other's experiences and 3) having ownership leading to the ownership of the self and of the groups they existed in. The emergent grounded theory revealed a Basic Social Process that conveyed the operation of three interrelated factors that helped to improve patients' self-efficacy and in turn their ability to engage effectively in their disease self-management. Through an action research approach the group work was led in a facilitative way, enabling the participants to work collaboratively with the researcher practitioner to choose and shape the care delivery. The core category of 'taking back the self-understanding the whole revealed the impact that this care delivery method had upon re-adjusting the balance of power between health professional and service users and its relationship to refreshing and improving disease self-management and self-efficacy.Community matron intervention using a model of group learning embedded in a social learning framework for those living with multiple long-term conditions can lead to more effective support, through improving self-efficacy and related self-management ability.