Abstract
Self-management is widely promoted in rehabilitation to empower disabled people and those living with long-term conditions, yet closer examination shows that this concept is complex, contested, and shaped by divergent philosophies and expectations. Drawing on research in Aotearoa, New Zealand, this chapter critically examines the language and practice of self, management, self-management, self-management support, and supported self-management, reframing rehabilitation around relationships, culture, equity, and organisational contexts. It challenges individualist framings that obscure structural determinants of health and entrench inequity. Three interconnected themes structure the argument: the shifting balance between individual autonomy and collective ways of being; the centrality of trusted, culturally safe relationships sustained over time; and supported decision-making as rights-based, enabling practice that advances equitable participation. Indigenous worldviews, including those of Māori, tāngata whenua (original people of the land), and Pacific peoples, centre whānau (family), community, and collective wellbeing, calling for support that extends beyond the individual and is co-designed and sustained in everyday life. Recognising whānau, community, as well as individual capacities as integral to rehabilitation, this chapter positions supported self-management as inseparable from identity as it is lived and negotiated with others and within health systems. Situating supported self-management within social, cultural, environmental, and organisational contexts moves rehabilitation beyond a narrow clinical focus towards practices that strengthen collective capacity, enable participation, and honour identity through relationship-centred support across clinical and community settings.