ArticleJournal of advanced nursing2026
Shared Decision-Making and Trajectories of Self-Management Confidence in Nurse-Led Chronic Condition Care: A Longitudinal Evaluation.
Article in Journal of advanced nursing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
4 authors.
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Abstract
aimTo examine whether shared decision-making at baseline is associated with trajectories of self-management confidence over 12 months among individuals living with chronic conditions attending nurse-led clinics.
designA longitudinal design.
methodsIndividuals with at least one clinician confirmed chronic condition were recruited from six nurse-led primary care clinics between March and September 2022. Data collection took place between March 2022 and September 2023, with baseline, 6 and 12-month assessments completed within routine follow-up contacts. Self-management confidence was measured using the Self-Efficacy for Managing Chronic Disease Scale, and perceived shared decision-making was assessed using the nine-item Shared Decision-Making Questionnaire (SDM-Q-9). Linear mixed-effects modelling examined changes in confidence over time and associations with baseline shared decision-making, adjusting for age, gender, education and number of chronic conditions.
resultsOf 157 eligible individuals approached, 151 consented to participate (96.2%), and 146 were retained at 12 months (96.7%). Mean self-management confidence increased from 40.2 at baseline to 44.5 at 12 months. In adjusted models, confidence was significantly higher at 6 months (β = 2.63, 95% CI: 1.54-3.72, p < 0.001) and 12 months (β = 4.21, 95% CI: 2.93-5.49, p < 0.001) compared with baseline. Higher baseline shared decision-making was positively associated with repeated confidence scores across follow-up (β = 0.10, 95% CI: 0.04-0.16, p = 0.002). The association was stronger among participants aged under 60 years.
conclusionsWithin established nurse-led chronic condition care, perceived shared decision-making was statistically associated with subsequent trajectories of self-management confidence over 12 months. Confidence demonstrated gradual change rather than stability within routine practice. IMPLICATIONS: Strengthening the visibility and consistency of collaborative dialogue within nurse-led consultations may support self-management confidence. Structured conversational approaches that help nurses enact shared decision-making more explicitly warrant further evaluation in primary care. PATIENT OR PUBLIC CONTRIBUTION: No patients were involved in study design.
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