Participation, roles, and the dynamics of change in a group-delivered self-management course for people living with HIV.

Interventions designed to change behavior delivered to groups rather than individuals are popular in health promotion and self-management. The 7-week positive self-management program (PSMP) for people with HIV status is adapted from a psychoeducational program designed to increase people's capacity to manage their conditions by enhancing self-efficacy. A case study using mixed qualitative methodology included pre- and postcourse interviews with 14 participants plus participant observation and focused on changes in attitude toward self-management responsibility. The authors identified a precourse typology of motivations and expectations: Hopeless, Recovery phase, or Questioning phase. Participants adopted roles (information seekers or information givers) related to these types. Some expectations and problems were not dealt with because the PSMP's philosophical grounding prioritized improvement of self-efficacy, precluding engagement with material and social needs. Collective user-defined need and support from host organizations might be more important in improving self-management than the structured content of chronic disease self-management programs.