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Being creative and resourceful: Individuals’ abilities and possibilities for self-management of chronic illness
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Att vara kreativ och resursstark : Individers förmåga och möjlighet till egenvård av kronisk sjukdom (Swedish)
Abstract [en]

Individuals’ self-management styles are crucial for how they manage to live with illness. Commonly investigated factors include social support, self-efficacy, health beliefs, and demographics. There is a gap in the literature with regard to in-depth studies of how those factors actually influence an individual’s self-management.

 

The aim of this thesis was to investigate the underlying mechanisms of self-management from the perspective of individuals living with chronic illness.

 

Interviews were conducted with 47 individuals with various chronic illnesses, some of them repeatedly over two and a half years (a total of 107 interviews). The material was analysed with; constructive grounded theory, content analysis, phenomenography, and interpretive description.

 

The Self-management Support Model identified aspects that influenced participants’ self-management: economic and social situation, social support, views and perspectives on illness, attribution of responsibility, and ability to integrate self-management into an overall life situation. For example, individuals with a life-oriented or disease-oriented perspective on illness prioritized different aspects of self-management. People who attributed internal responsibility performed a more complex self-management regimen than individuals who attributed external responsibility. In conclusion, individuals who were creative and resourceful had a better chance of tailoring a self-management regimen that suited them well. People in more disadvantaged positions (e.g., financial strain, limited support, or severe intrusive illness) experienced difficulty in finding a method of self-management that fit their life situation.

 

These findings can inspire healthcare providers to initiate a reflective dialogue about self-management with their patients.

Place, publisher, year, edition, pages
Sundsvall: Mittuniversitetet , 2011. , 82 p.
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 109
Keyword [en]
Self-management, self-care, chronic illness, chronic disease, qualitative research, life conditions, beliefs and values, self-management integration, longitudinal
Keyword [sv]
Egenvård, sjukdomshantering, kronisk sjukdom, kvalitativ forskning, livsvillkor, värderingar, egenvårds integrering, hantering, anpassning
National Category
Nursing
Identifiers
URN: urn:nbn:se:miun:diva-13512ISBN: 978-91-86694-39-5OAI: oai:DiVA.org:miun-13512DiVA: diva2:410132
Public defence
2011-05-13, Lubbesalen, M108, Mittuniversitetet, Sundsvall, 10:15 (Swedish)
Opponent
Supervisors
Projects
Exploring individuals’ conceptions as a way to understand self-management among people living with long term medical conditions
Available from: 2011-04-13 Created: 2011-04-12 Last updated: 2012-07-30Bibliographically approved
List of papers
1. An ongoing process of inner negotiation – a Grounded Theory study of self-management among people living with chronic illness
Open this publication in new window or tab >>An ongoing process of inner negotiation – a Grounded Theory study of self-management among people living with chronic illness
2009 (English)In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, Vol. 1, no 4, 283-293 p.Article in journal (Refereed) Published
Abstract [en]

Aim.  The aim of this study was to better understand the main concern of self-management processes among people with chronic illness.

Background.  One aspect of living with chronic illness is self-management that can reduce the illness impact on daily life and promote future health. Although factors that influence self-management have been identified in previous research, little attention has been brought to the process of making self-management decisions. In clinical settings, use of a theory could facilitate patient-empowering approaches.

Method.  The data collection for this Grounded Theory was mostly conducted in 2006. Data were collected by interviews with 26 adults with a variety of chronic illnesses, including rheumatoid arthritis, diabetes mellitus, inflammatory bowel syndrome, multiple sclerosis, ischaemic heart disease and chronic kidney failure.

Results.  Individuals are conflicted by competing preferences when taking decisions about self-management. Consequently, the decision-making process can be understood as an ongoing inner negotiation between different incompatible perspectives, e.g. social needs vs. medical needs. The process of negotiating self-management starts with the individual’s considering beliefs about health and illness, which make the individual face illness threats and the need for self-management. Several aspects influence negotiating self-management namely, assessing effects of self-management; evaluating own capacity; perceiving normality or stigmatisation; and experiencing support and external resources. The process has been demonstrated in a model.

Conclusions.  The process of negotiating self-management is an ongoing inner debate rather than a one-time decision. This opens up new ways of understanding, and communicating with, patients. The described model also links behavioural theories and research findings in a comprehensive understanding.

Relevance to clinical practice.  This model could be applicable as a communication tool for health-care providers in identifying barriers to, and resources in, self-management behaviour among individuals with chronic illness.

Keyword
chronic disease, self-care, health beliefs, qualitative, Grounded Theory
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-10456 (URN)10.1111/j.1752-9824.2009.01039.x (DOI)
Projects
Exploring individuals’ conceptions as a way to understand self-managment among people living with long term medical conditions
Available from: 2009-12-01 Created: 2009-12-01 Last updated: 2014-07-08Bibliographically approved
2. Who's in charge? The role of responsibility attribution in self-management among people with chronic illness
Open this publication in new window or tab >>Who's in charge? The role of responsibility attribution in self-management among people with chronic illness
2010 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 81, no 1, 94-100 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To explore how responsibility attribution influences self-management regimens among people with chronic illness. METHODS: This qualitative content analysis included 26 interviews with people living with chronic illness. RESULTS: The participants attributed responsibility to internal, external or a combination of these factors, meaning that they either assumed responsibility for self-management or considered other people or factors responsible. Internal responsibility was associated with a multifaceted self-management regimen, whereas external responsibility was related to "conventional" self-management such as taking medication, managing symptoms and lifestyle changes. CONCLUSION: How responsibility is attributed is vital for the way in which individuals perform self-management. In this study, those who attributed responsibility to external factors mainly performed recommended behaviours to control their illness. In contrast, to take charge of their illness and be an active participant in the care, individuals must take responsibility for themselves, i.e. internal responsibility. PRACTICE IMPLICATIONS: Health-care providers should acknowledge and support individuals' wishes about various levels of responsibility as well as different kinds of patient-provider relationships.

Place, publisher, year, edition, pages
Elsevier, 2010
Keyword
Self-management; chronic disease; decision-making; qualitative; interviews; content
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-10661 (URN)10.1016/j.pec.2009.12.007 (DOI)000282070900016 ()20060256 (PubMedID)2-s2.0-77955920242 (ScopusID)
Projects
Exploring individuals' conceptions as a way to understand self-management among people living with long term medical conditions.
Available from: 2009-12-14 Created: 2009-12-14 Last updated: 2016-09-22Bibliographically approved
3. The influence of illness perspectives on self-management of chronic disease
Open this publication in new window or tab >>The influence of illness perspectives on self-management of chronic disease
2011 (English)In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, Vol. 3, no 2, 109-118 p.Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Singapore: Blackwell Publishing Ltd, 2011
Keyword
Chronic illness, illness representatives, health beliefs, illness perspectives, self-management, self-care
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-13419 (URN)
Projects
Exploring individuals conceptions as a way to understand self-management among people living with long term medical conditions.
Available from: 2011-03-28 Created: 2011-03-28 Last updated: 2011-07-18Bibliographically approved
4. The integration of chronic illness self-management
Open this publication in new window or tab >>The integration of chronic illness self-management
2012 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 22, no 3, 332-345 p.Article in journal (Refereed) Published
Abstract [en]

Self-management is crucial for people living with chronic diseases, but the actual process of integrating self-management has not been explored in depth. In this article, we investigate the integration of self-management into the lives of people with chronic illness. In this longitudinal study, we used an interpretive description approach. Twenty-one individuals were interviewed regularly during the first 3 years after they were diagnosed with a chronic condition. We found self-management integration to be an ongoing process that included four phases: seeking effective self-management strategies, considering costs and benefits, creating routines and plans of action, and negotiating self-management that fits one's life. The participants managed the phases according to their context, e.g., illness experience, life situation, personal beliefs, and social support. Health care providers should therefore facilitate self-management integration by providing support that is adjusted to the person's phase of self-management integration and life context.

Keyword
comparative analysis; coping and adaptation; health behavior; illness and disease, chronic; interpretive methods; interviews; longitudinal studies; research, qualitative; self-care
National Category
Health Sciences
Identifiers
urn:nbn:se:miun:diva-12396 (URN)10.1177/1049732311430497 (DOI)000299894300004 ()2-s2.0-84856754262 (ScopusID)
Available from: 2010-12-03 Created: 2010-12-03 Last updated: 2012-08-03Bibliographically approved

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