My health, myself: a qualitative study on motivations for effective chronic disease self-management among community dwelling adults

Abstract Background Chronic diseases continue to be a significant cause of morbidity and mortality despite modifiable risk factors. This suggests that current primary healthcare provision needs to delve beyond patient education, to understand the motivators that drive patients to undertake chronic disease self-management. Understanding these motivations within the context of a multi-cultural community can facilitate tailored support for chronic disease self-management. Objectives To explore the motivations behind effective chronic disease self-management in community dwelling adults in Singapore. Methods A qualitative descriptive study was carried out in five clinics in a large medical centre. Twelve participants who were assessed to be optimally managing their chronic diseases were recruited using purposive sampling. Individual in-depth interviews were conducted until data saturation, with data thematically analysed. Results Three salient themes emerged from the data. Firstly, ‘Regaining self-control, avoiding complications’ describes the participants’ journey towards personal mastery in self-management, as well as a fear of debilitating complications resulting in their desire for good health. Secondly, ‘Preserving social identities and roles’ illustrates how participants yearn to maintain their pre-existing roles and functions through maintenance of their health. Finally, ‘Accessing proximal support systems’ highlights resources and supports surrounding the participants that encourage continued chronic disease self-management. Within each theme, specific motivators and challenges encountered by participants in their self-management journey were discussed. Conclusions Findings can prompt primary healthcare providers to leverage on the patients’ life goals and social roles in chronic disease self-management support. This may empower patients to engage in self-management and strengthen primary care provision.

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Characteristics of self-management among patients with complex health needs: a thematic analysis review

BMJ Open ◽

10.1136/bmjopen-2018-028344 ◽

2019 ◽

Vol 9 (5) ◽

pp. e028344 ◽

Cited By ~ 8

Author(s):

Annie-Pier Gobeil-Lavoie ◽

Maud-Christine Chouinard ◽

Alya Danish ◽

Catherine Hudon

Keyword(s):

Chronic Diseases ◽

Thematic Analysis ◽

Healthcare Providers ◽

Self Management ◽

Management Support ◽

Management Skills ◽

Healthcare Needs ◽

Frequent Use ◽

Dominant Condition ◽

Use Of Health Services

ObjectiveThere is a gap of knowledge among healthcare providers on characteristics of self-management among patients with chronic diseases and complex healthcare needs. Consequently, the objective of this paper was to identify characteristics of self-management among patients with chronic diseases and complex healthcare needs.DesignThematic analysis review of the literature.MethodsWe developed search strategies for the MEDLINE and CINAHL databases, covering the January 2000–October 2018 period. All articles in English or French addressing self-management among an adult clientele (18 years and older) with complex healthcare needs (multimorbidity, vulnerability, complexity and frequent use of health services) were included. Studies that addressed self-management of a single disease or that did not have any notion of complexity or vulnerability were excluded. A mixed thematic analysis, deductive and inductive, was performed by three evaluators as described by Mileset al.ResultsTwenty-one articles were included. Patients with complex healthcare needs present specific features related to self-management that can be exacerbated by deprived socioeconomic conditions. These patients must often prioritise care based on one dominant condition. They are at risk for depression, psychological distress and low self-efficacy, as well as for receiving contradictory information from healthcare providers. However, the knowledge and experiences acquired in the past in relation to their condition may help them improve their self-management skills.ConclusionsThis review identifies challenges to self-management for patients with complex healthcare needs, which are exacerbated in contexts of socioeconomic insecurity and proposes strategies to help healthcare providers better adapt their self-management support interventions to meet the specific needs of this vulnerable clientele.

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Protocol for a randomised controlled trial of chronic disease self-management support for older Australians with multiple chronic diseases

Contemporary Clinical Trials ◽

10.1016/j.cct.2011.08.001 ◽

2011 ◽

Vol 32 (6) ◽

pp. 946-952 ◽

Cited By ~ 12

Author(s):

Richard L. Reed ◽

Malcolm Battersby ◽

Richard H. Osborne ◽

Malcolm J. Bond ◽

Sara L. Howard ◽

...

Keyword(s):

Chronic Disease ◽

Randomised Controlled Trial ◽

Chronic Diseases ◽

Controlled Trial ◽

Self Management ◽

Management Support ◽

Randomised Controlled ◽

Multiple Chronic Diseases

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PrimaryCare@COVID-19: the implementation of digital monitoring services for patients with chronic diseases during the Covid-19 pandemic (Preprint)

10.2196/preprints.24181 ◽

2020 ◽

Author(s):

Luis Velez Lapão ◽

Mariana Santos ◽

Melanie Maia ◽

Vasco Pedrosa ◽

Jorge Seixas ◽

...

Keyword(s):

Chronic Diseases ◽

Primary Healthcare ◽

Primary Care Physicians ◽

Design Science ◽

Digital Health ◽

Healthcare Providers ◽

Healthcare Services ◽

Healthcare Provision ◽

The Impact ◽

Primary Healthcare Centers

BACKGROUND The COVID-19 pandemic is straining health systems and disrupting the delivery of healthcare services, in particular for the elderly and those with chronic conditions, who are particularly vulnerable to COVID-19 infection. OBJECTIVE The aim of this project is to support primary healthcare provision with a digital health platform that will allow primary care physicians and nurses to remotely manage the care of patients with chronic diseases or COVID-19 infections. METHODS The project followed the 6 steps of the Design Science implementation methodology framework: problem identification and motivation, definition of the objectives aligned with Goal-oriented care, artefact design and development, solution demonstration, evaluation, and communication. RESULTS The digital platform was developed for the specific objectives of the project and successfully piloted in three primary healthcare centers in the Lisbon Health Region. The health professionals were able to safely and thoroughly manage their first patients remotely with high degrees of satisfaction. The first COVID-19 messages were sent to the patients, addressing infodemic issues. CONCLUSIONS Although still in the first steps of implementation, we are seeing promising results with a positive uptake by healthcare providers and patients. Further research is planned to evaluate the impact on patient’s health related outcomes. We are confident that this platform could be scaled-up to all primary healthcare centers in Portugal in the next months, ready to tackle a second wave of COVID-19.

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Theoretical and contextual considerations for self-management strategies of children and adolescents with chronic diseases: An integrative review

Journal of Child Health Care ◽

10.1177/13674935211013697 ◽

2021 ◽

pp. 136749352110136

Author(s):

Logan J Camp-Spivey ◽

Ayaba Logan ◽

Michelle Nichols

Keyword(s):

Children And Adolescents ◽

Chronic Diseases ◽

Management Strategies ◽

Healthcare Providers ◽

Integrative Review ◽

Self Management ◽

Intervention Delivery ◽

Management Interventions ◽

Technological Platforms ◽

Management Behaviors

The primary aim of this integrative review was to critically evaluate and synthesize published, peer-reviewed research to better understand self-management strategies of children and adolescents with chronic diseases. This review was guided by Whittemore and Knafl’s methodological framework. The Pediatric Self-management Model provided the theoretical framework for understanding how self-management behaviors operate within the domains of individual, family, community, and healthcare systems. In June 2019, the electronic databases of EBSCOhost, PubMed, and Scopus, along with reference lists of applicable studies, were searched for appropriate publications. The initial searches yielded 920 citations. Of these, 11 studies met inclusion criteria. A key finding was that involving children and adolescents in the design and delivery phases of interventions was most effective in improving self-management when the interventions did not outweigh cognitive ability or maturity level. In addition, incorporating self-efficacy promotion into self-management interventions may lead to greater sense of responsibility and improved health outcomes. In terms of intervention delivery of self-management strategies, the use of technological platforms and devices was revealed as a promising avenue for youth. A final implication was the importance of family members, peers, and healthcare providers in supporting children and adolescents in adopting self-management behaviors.

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The Situated Influence of Chronic Pain Perception on Chinese Older Adults’ Self-Management in Home Care

Geriatrics ◽

10.3390/geriatrics3040064 ◽

2018 ◽

Vol 3 (4) ◽

pp. 64

Author(s):

Fang Liu ◽

Min Tong

Keyword(s):

Older Adults ◽

Chronic Pain ◽

Chronic Disease ◽

Pain Perception ◽

Community Dwelling ◽

Self Management ◽

Chinese Older Adults ◽

Care Experience ◽

Management Capacity ◽

Important Others

Background and objective: Worldwide, 26 million older adults die from chronic disease, and chronic pain is typically a part of the experience of chronic disease. This study explores the perception of chronic pain for home-dwelling Chinese older adults and its influence on (1) self-management ability and (2) management and reduction of chronic pain. Methods: Adopting a qualitative study design, we conducted in-depth interviews with 10 Chinese community-dwelling older adults who experience chronic pain. Half of our informants perceive chronic pain, whereas the other half, diagnosed with Alzheimer’s disease, do not report that they perceive chronic pain. Data were analyzed with inductive thematic analysis. Results: Chronic pain perception plays important roles in (1) defining the challenge of self-management, (2) connecting previous caretaking experience, (3) adjusting the identity of self-management, (4) acquiring support from important others and (5) re-planning self-management arrangements. Conclusion: Pain perception helps to motivate Chinese older adults to face health challenges and regain self-management capacity through adjustments in self-identity and care experience with the support of important others. Pain perception can consolidate the situation of independent living of older adults. It helps to motivate Chinese older adults to face health challenges and regain self-management capacity.

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Self‐management support for patients with chronic disease: potential and questions

The Medical Journal of Australia ◽

10.5694/mja17.01002 ◽

2018 ◽

Vol 208 (2) ◽

pp. 66-67

Author(s):

Nicholas A Zwar ◽

Sarah M Dennis

Keyword(s):

Chronic Disease ◽

Self Management ◽

Management Support

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Electronic, mobile and telehealth tools for vulnerable patients with chronic disease: a systematic review and realist synthesis

BMJ Open ◽

10.1136/bmjopen-2017-019192 ◽

2018 ◽

Vol 8 (8) ◽

pp. e019192 ◽

Cited By ~ 24

Author(s):

Sharon Parker ◽

Amy Prince ◽

Louise Thomas ◽

Hyun Song ◽

Diana Milosevic ◽

...

Keyword(s):

Chronic Disease ◽

Health Literacy ◽

Healthcare Providers ◽

Chronic Health Condition ◽

Vulnerable Groups ◽

Self Management ◽

Future Research ◽

Ehealth Literacy ◽

Health Technologies ◽

Vulnerable Patients

ObjectivesThe objective of this review was to assess the benefit of using electronic, mobile and telehealth tools for vulnerable patients with chronic disease and explore the mechanisms by which these impact patient self-efficacy and self-management.DesignWe searched MEDLINE, all evidence-based medicine, CINAHL, Embase and PsychINFO covering the period 2009 to 2018 for electronic, mobile or telehealth interventions. Quality was assessed according to rigour and relevance. Those studies providing a richer description (‘thick’) were synthesised using a realist matrix.Setting and participantsStudies of any design conducted in community-based primary care involving adults with one or more diagnosed chronic health condition and vulnerability due to demographic, geographic, economic and/or cultural characteristics.ResultsEighteen trials were identified targeting a range of chronic conditions and vulnerabilities. The data provided limited insight into the mechanisms underpinning these interventions, most of which sought to persuade vulnerable patients into believing they could self-manage their conditions through improved symptom monitoring, education and support and goal setting. Patients were relatively passive in the interaction, and the level of patient response attributed to their intrinsic level of motivation. Health literacy, which may be confounded with motivation, was only measured in one study, and eHealth literacy was not assessed.ConclusionsResearch incorporating these tools with vulnerable groups is not comprehensive. Apart from intrinsic motivation, health literacy may also influence the reaction of vulnerable groups to technology. Social persuasion was the main way interventions sought to achieve better self-management. Efforts to engage patients by healthcare providers were lower than expected. Use of social networks or other eHealth mechanisms to link patients and provide opportunities for vicarious experience could be further explored in relation to vulnerable groups. Future research could also assess health and eHealth literacy and differentiate the specific needs for vulnerable groups when implementing health technologies.

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Promoting Self-Management of Chronic Health Conditions

10.1093/med-psych/9780190606145.001.0001 ◽

2017 ◽

Cited By ~ 1

Keyword(s):

Management Practices ◽

Healthcare Providers ◽

Chronic Health Conditions ◽

Health Conditions ◽

Self Management ◽

Psychological Interventions ◽

Management Support ◽

Chronic Health ◽

Treatment Plans

This book explores the theories and practices that help to facilitate self-management of chronic health conditions (also known as chronic impairments or chronic diseases). It consists of four parts, in addition to an introductory chapter and a chapter on defining self-management, for a total of 22 chapters. This book includes discussions about self-management models, psychological interventions, and collaborative care on both individual and systemic levels for the promotion of self-management. Self-management requires that individuals understand the range of symptoms related to their specific chronic impairment, what those symptoms may indicate, and what actions to take to address those symptoms. Healthcare providers are an integral part of providing self-management support (SMS) to these individuals. Self-management includes the micro-decisions that individuals with chronic health conditions make about their conditions and the macro-decisions (e.g., creating treatment plans) that healthcare providers make in collaboration with individuals with chronic health conditions. This book focuses on exploring a range of self-management practices that can empower individuals with chronic health conditions to be less dependent on healthcare systems and, ultimately, to be more in control of their lives.

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The experiences of clients and healthcare providers regarding the provision of reproductive health services including the prevention of HIV and AIDS in an informal settlement in Tshwane

Health SA Gesondheid ◽

10.4102/hsag.v21i0.936 ◽

2016 ◽

Vol 21 ◽

pp. 67-76

Author(s):

M. L.S. Mataboge ◽

S. Beukes ◽

A. G.W. Nolte

Keyword(s):

Reproductive Health ◽

Health Services ◽

Primary Healthcare ◽

Informal Settlement ◽

Healthcare Providers ◽

Hiv And Aids ◽

Reproductive Health Services ◽

Healthcare Provision ◽

Reproductive Healthcare ◽

Prevention Of Hiv

Globally challenges regarding healthcare provision are sometimes related to a failure to estimate client numbers in peri-urban areas due to rapid population growth. About one-sixth of the world's population live in informal settlements which are mostly characterised by poor healthcare service provision. Poor access to primary healthcare may expose residents of informal settlement more to the human immunodeficiency virus (HIV) and to acquired immunodeficiency syndrome (AIDS) than their rural and urban counterparts due to a lack of access to information on prevention, early diagnosis and treatment. The objective of this study was to explore and describe the experiences of both the reproductive health services' clients and the healthcare providers with regard to the provision of reproductive health services including the prevention of HIV and AIDS in a primary healthcare setting in Tshwane. A qualitative, exploratory and contextual design using a phenomenological approach to enquire about the participants' experiences was implemented. Purposive sampling resulted in the selection of 23 clients who used the reproductive healthcare services and ten healthcare providers who were interviewed during individual and focus group interviews respectively. Tesch's method for qualitative data analysis was used. Ethical principles guided the study, and certain strategies were followed to ensure trustworthiness. The findings revealed that females who lived in informal settlements were aware of the inability of the PHC setting to provide adequate reproductive healthcare to meet their needs. The HCPs acknowledged that healthcare provision was negatively affected by policies. It was found that the community members could be taught how to coach teenagers and support each other in order to bridge staff shortages and increase health outcomes including HIV/AIDS prevention.

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