A Qualitative Exploration of Experiences of Self-Management for Long-Term Health Conditions in the UK

Harrison, Sophie and Staniford, Leanne and Waterman, Sam (2026) A Qualitative Exploration of Experiences of Self-Management for Long-Term Health Conditions in the UK. PhD thesis, Lancaster University.

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Abstract

This thesis examines self-management of long-term conditions in the UK through a systematic literature review, empirical research and critical appraisal. First, the systematic literature review used a thematic synthesis to explore healthcare professionals’ attitudes and experiences regarding their role in supporting the self-management of physical long-term conditions in routine UK practice. Analysis of 16 qualitative papers identified that role enactment was shaped by interactions between professional identity, perceptions of risk and responsibility and wider organisational constraints. Although person-centred roles were valued, these forces shaped routine practice towards more directive control-based approaches which were positioned as safer, more efficient and sustainable within the current UK healthcare context. These findings highlight a persistent gap between person-centred policy ambitions and the realities of clinical practice and argue that improving implementation requires system-level change alongside individual behaviour change approaches. The empirical study explored how people with Postural Tachycardia Syndrome (PoTS) in the UK experience self-management between one to six years post-diagnosis. The study took a qualitative approach using Interpretative Phenomenological Analysis. Nine participants took part in online semi-structured interviews, which resulted in three themes: 1) Negotiating a complex web of self-management, 2) Searching for a sense of control within an unpredictable body and 3) Self-management as individual responsibility. Participants described self-management as a complex, individual and dynamic process with narratives focused on achieving symptom control and maintaining wellbeing whilst living with PoTS. There was a strong sense that self-management was their own personal responsibility, alongside the challenges of managing an uncertain and often misunderstood condition. The results are discussed in relation to a need for future research and improved self-management support for individuals living with PoTS. Finally, the critical appraisal builds on the literature review and empirical study, considering strengths and limitations, as well as offering reflections and insights into the research process.