Table 1.

Steps of the Flinders Program

Partners in Health Scale	A self-reported 12 item questionnaire which assesses seven principles of attributes of a person’s self-management [26]. It is a patient assessed Likert-rated validated questionnaire informed by the WHO and Australian National Chronic Disease Strategy principles of self-management. It enables measurement of perceived change over time where 0 = less favourable and 8 = more favourable self-management capacity.
Cue and Response Interview	An adjunct to the PIH using open-ended questions or cues for the health worker to explore the patient’s responses to the PIH in more depth, with the patient and worker comparing their Likert-ratings to identify agreed good self-management, agreed issues to be addressed, and any discrepancies in views that can then be discussed as part of formulation of a self-management care plan. It enables the strengths and barriers to self-management to be explored from perspectives of both the patient and the health worker, and checks assumptions that either party may have, as part of a motivational process.
Problem and Goals Assessment	Defines a problem statement from the patient’s perspective (the problem, its impact and how it makes them feel) and identifies action-based specific, measurable, achievable, realistic and timely (SMART) behavioural goals that the patient can work towards. It is Likert-rated, allowing measurement of progress over time where 0 = not a problem and 8 = a significant problem; and goal statements: 0 = no progress towards achievement and 8 = achieved.
Chronic Condition Management Care Plan	Includes self-management issues, aims, steps to achieve them, who is responsible and date for review.