Systemic Models of Self-Management

Researchers and healthcare policy analysts have called for systemic change in healthcare systems, because those systems typically do not incorporate long-term planning of chronic health condition care. There is an international movement to create comprehensive, integrated healthcare models that can better assist individuals who have chronic health conditions. This chapter includes a discussion of the definition of self-management support (SMS) and how it is different from self-management, a description of the typical components of SMS interventions, how SMS is different than disease management programs, and some examples of SMS programs. This chapter also covers several systemic models of self-management, including the Chronic Care Model and the Innovative Care for the Chronic Conditions Framework. It ends with brief sections on the economic reasons to promote SMS and integrated healthcare and on the future of self-management.

Self-Management of Multiple Sclerosis

Multiple sclerosis (MS) is a chronic neurological condition that can impact one’s health and functioning, role participation, and quality of life in a wide variety of ways. Self-management is increasingly recognized as a critical component of MS care and a person-directed approach to health and wellness. Given the range of ways that MS may affect physical and cognitive as well as psychosocial functioning, effective and comprehensive MS self-management may require a broad range of knowledge and resources. Thus this chapter explores current perspectives on MS self-management, evaluates the research evidence and current research directions, and identifies effective practices in MS self-management.

Self-Management of Hearing Impairment

Hearing impairment is defined as hearing loss that leads to difficulties in hearing, or deafness, and affects an estimated 360 million people worldwide. Consequences of hearing impairment include difficulties in communication, restricting social participation, and leading to feelings of isolation. Hearing impairment cannot be cured, but its consequences can be reduced with self-management whereby the individual adopts, refines, and maintains health behaviors, supported through the provision and availability of suitable interventions. The barriers to self-management are many and should be explored to inform decision-making between the clinician and the individual with hearing impairment. The clinician can then facilitate self-management that is informed, realistic, and fully reflects the preferences and values of the individual.

Self-Management of Cardiac-Related Health Issues

One of the strongest means by which to reduce the risk of cardiac events’ recurrence and mortality is via restructuring major lifestyle habits and self-management of one’s risk factors. The therapeutic recommendations consists of smoking cessation, changing dietary choices, exercising on a regular basis, taking medication, and managing one’s psychological distress. Yet many individuals with cardiac impairments find it extremely difficult to manage them. Most barriers for self-management can be organized under the following coordinates: systemic and sociocultural barriers, gender-related barriers, and psychologically related barriers. The demanding task of improving individuals’ self-management is not inherently of individuals and their family members only. Health systems and health providers within them should develop and apply novel and effective procedures to support individuals to self-manage their life situation, thus transforming it from crisis to challenge.

Self-Management of Arthritis

Arthritis is ranked among the top causes of disability in the United States and worldwide. Despite recent improvements in medications and medical treatment, there is no known cure for arthritis. Providing evidence-based psychoeducation and counseling services to people with arthritis lessens the impact of pain-related symptoms and disability on the individual and society. The purpose of this chapter is to provide an overview of the most common arthritic conditions, co-occurring physical conditions, and psychosocial factors associated with arthritis. Barriers to self-management and existing self-management programs are also discussed along with the current state of scientific evidence. The chapter concludes with some questions for future research.

Introduction

The fundamental goal of this book on self-management is to elaborate on the theories and practices that can help individuals with chronic health conditions to become as independent as possible by self-managing their conditions. The present chapter introduces the concept of self-management. This concept fundamentally denotes that individuals with chronic health conditions take responsibility for managing their chronic health conditions to the best of their abilities. Self-management also involves collaboration with healthcare providers. This chapter discusses several reasons why there is a need to study promoting self-management, including perspectives related to the global increase in the prevalence of chronic health conditions, the societal costs of chronic health conditions, and the time limitations of healthcare professionals providing care. It also includes a discussion of the terminology that is used in this book and concludes with an overview of the content provided by the sections of this book.

Self-Management of Pain

Most chronic pain sufferers are treated primarily with biocentric approaches (e.g., pharmacological therapy, surgery) that do not adequately address the often devastating physical, social, and psychological pain sequalae. Self-management programs have the potential of filling a gap not only by assisting with pain management (e.g., facilitating the optimization of participation in prescribed treatments) but also by addressing the psychosocial consequences of pain. Self-management programs have been delivered in a variety of formats (e.g., through the use of groups, self-help books, and technology). With some inconsistencies in the literature, studies of the effectiveness of pain self-management have yielded promising results, although effect sizes tend to be small to moderate. More research is needed to clarify inconsistencies across studies and to directly compare the efficacy of different modes of program delivery.

Self-Management of HIV

Human immunodeficiency virus (HIV) is a chronic condition, currently requiring life-long medication and having potential impacts on physical health through pain, fatigue, adverse medication affects, and opportunistic infections and on mental health through depression and anxiety and the stigmatized nature of HIV. Self-management offers an important avenue to address these concerns, with current research suggesting interventions to support medication-taking, good nutrition, and peer support to boost mental health and optimize a person’s understanding of HIV. Further, knowledge is required to facilitate self-management. The challenges and interventions including legal issues around transmission of HIV are considered, highlighting the multidimensional nature of the condition.

Telemedicine

This chapter describes how different types of telemedicine can be used to increase self-management of individuals with chronic health conditions. Based on a number of systematic literature reviews, the potential benefits of telemedicine for individuals with diabetes, COPD, and heart failure are presented. Because telemedicine in many countries are considered a strategic solution to the demographic challenges that the healthcare systems are facing, the chapter also includes a presentation of the model for assessment of telemedicine (MAST) framework for assessing new telemedicine solutions, as well as recommendations for outcome assessment and methods for data collection. This information is provided for the potential benefit of managers and healthcare professionals in order to determine which telemedicine services could be used by their local healthcare systems for improving self-management of individuals with chronic health conditions.

Self-Management of Vision Impairments

Many of the eye conditions that lead to vision loss are long-term conditions that require ongoing management. Vision loss has a profound impact on an individual’s life: occupational, social, and recreational. Most vision loss is degenerative and progressive. Yet self-management of the consequences of the condition can empower individuals to maintain independence and to continue doing chosen activities. This chapter initially describes the prevalence of vision loss and the most common conditions causing vision loss in adults. It then describes functional limitations of vision loss and barriers and challenges to self-management. Finally, an overview of coping strategies and evidence-based interventions is provided.