A systematic review of validated instruments assessing healthcare professionals’ competence and performance for patients’ self-management support

Background

Supporting self-management is a crucial aspect of caring for patients with chronic conditions. However, integrating self-management support into healthcare professionals' practice is known to be challenging. The growing emphasis on improving self-management support as part of quality of care provided makes it necessary to have validated instruments to assess the competence and performance of healthcare professionals in implementing self-management support.

Objectives

To conduct systematic review to identify and critically appraise available validated instruments used to assess healthcare professionals’ self-assessed competence and/ or performance in providing self-management support for adult patients with chronic conditions or multimorbidity.

Methods

This systematic review was conducted according to COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) methodology and complied with the PRISMA-COSMIN Reporting guidelines for systematic reviews on outcome measurement instruments 2024. The rationale and methods were prespecified and reported in a protocol that was registered with PROSPERO (CRD42024562520). Six databases (CINAHL, PubMed, Scopus, Web of Science, Medic, and Health and Psychosocial Instruments) were systematically searched. Two independent reviewers screened the articles for eligibility, extracted the data, and assessed the methodological quality of the included studies and the psychometric properties of the instruments.

Results

Of the 15,139 studies screened, six met the inclusion criteria, each introducing a unique instrument. Five were original development and validation studies, while one described the adaptation of an existing instrument. Most instruments were informed by literature and expert input. Three assessed actual performance in delivering self-management support, two addressed both performance and competence, and one focused solely on competence - specifically attitudes, such as beliefs about the importance of supporting self-management. Structural validity and internal consistency were reported in all studies, with hypotheses testing for construct validity in four. Methodological quality, assessed via the COSMIN Risk of Bias checklist, was mixed, as was the quality of the instruments’ measurement properties.

Conclusions

Validated instruments assessing healthcare professionals’ competence and/or performance in self-management support are limited. Due to the broad nature of self-management support, the instruments reviewed vary in their characteristics, scope, and structure. Selecting the most suitable tool depends on the specific context and purpose.

Practise implications

This review supports researchers and clinicians in identifying valid and reliable instruments for practice, while also highlighting areas for further tool development. Such insights can inform the evaluation of current practices, training needs, and programme effectiveness, helping to better target resources and integrate self-management support into healthcare delivery.