Shared decision-making and trajectories of self-management confidence in nurse-led chronic condition care: a longitudinal evaluation

Aim: To 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. Design: A longitudinal design. Methods: Individuals 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. Results: Of 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. Conclusions: Within 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.