Policing Expert Patients

posted: 15/04/2010

The Expert Patients Programme (EPP) is to help people manage their own long term conditions better. A special version of the course is occasionally run by and for people living with HIV at BPNW in NW England.
 

There's an online version of the Department of Health Expert Patients Programme for the general public. Some of the people who joined that course decided to become course tutors and trainers for the EPP.

How well do those non-professional health staff – the online EPP tutors – engage, guide and attempt to manage people with long-term conditions to be ‘good’ self-health managers?

This study by Manchester University gives an insight into the good cop / bad cop roles some online EPP tutors take on. Some tutors attempt to ‘police’ people learning how to health self-management, and other tutors try to boost people’s mental state and skills. 

Moral tones and judgements

The moral tone that tutors sometimes use shows their ignorance of theories and methods used by adult educationalists (where the educator is to enable and support the pupil to learn for themselves, not tell them off), as well as the strong need they felt to stand up for the EPP. Being strong advocates meant they defended the course, even when it at times caused obvious upset, such as during the session on Living Wills.
 

Policing gave tutors permission to comment on participants' behaviour in ways which were not motivating or enabling, but which adopted a moral tone about expectations of normal good behaviour.
'I'm sure you are fully aware that comfort eating does exactly the opposite to what we would like to happen' (class 67)

There's a lot that is good about EPP, but online tutors can undermine some of the benefits by moralising and criticising behaviour that is judged to be less than perfectly healthy.

Full article free  BMC Health Services Research 2009, Volume 9, Issue 93