Implementation and evaluation of the stepped care intervention "Raise your strengths" in primary care: a pretest-posttest pilot study

According to the Volksverkenning 2014, approximately 5.3 million people have
one or more chronic illness. It is estimated that the number of people with a
chronic disease in 2030 will rise to 7 million. Having a chronic illness is
related to both adverse social and personal consequences. The demand for care
and thus the importance of self-management is increasing. However, existing
self-management interventions focus primarily on medical management and hardly
on role and emotional management. More attention should be paid to personal
problems and personal resources of people with a chronic illness, because they
influence the level of self-management. Due to the increasing demand for care
in GP care, the shift from the 2nd to the first line and the recent development
of the presence of practice assistants in the GP practice, GP care seems to be
a designated setting to increase the self-management of people with a chronic
illness. The stepped care approach "Raise your strengths" is in line with the
needs of general practitioners and practitioners, because this approach has
been developed in co-creation with them. The stepped care approach is based on
the strengths approach. The strengths approach is a perspective where looking
at problems is in balance with looking at strengths and the environment of a
person. Due to the stepped care approach, customized care takes place. The
strengths approach seems suitable for people with a chronic somatic symptoms
because the use of strengths is a predictor for subjective well-being. A higher
level of well-being is related to both mental and physical health and promotes
both recovery and survival in people with a chronic disease. Emotional
well-being predicts the long-term prognosis in people with a chronic disease.
In addition, research has shown that the use of strengths is linked to health
behavior such as: an active way of life, healthy eating and physical fitness.
We expect that the stepped care approach "Raise your strengths" will increase
self-management and wellbeing of patients with chronic somatic symptoms.

The objective of the study is as follows:
- The development of a protocol to provide the stepped care intervention "Raise
your strengths" in primary care for patients with chronic somatic symptoms
- To gain insight into the possible effects of "Raise your strengths" on
self-management and wellbeing.

Pilot study with one group and a pre- and posttest.

The stepped care approach "Raise your strengths" includes three steps. The
first step is to get acquainted with the approach during a meeting with the GP.
The second step is the "Right on Strengths" intervention carried out by the
mental health nurse. With the "Right on Strengths" intervention, the
participant gets more insight into what his strengths are. The participant sets
personal goals. In addition, the participant learns how he can use his
strengths to achieve his goals or to deal with difficult situations. If it
turns out that the participant is insufficiently capable of dealing flexibly
with his goals, for example because they are threatened by the chronic disease,
the third step takes place. The third step is the intervention "Right on
Target" and is also carried out by the mental health nurse. With "Right on
Target", the participant learns to apply different target strategies in a
flexible way.

There is no known or worthwhile mentioning burden and risk for the participant
by participating in this study. The burden of the participant is high but it
will be divided into 12 to 16 weeks and can be determined by the participants
themselves to a large extent.