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An ongoing process of inner negotiation – a Grounded Theory study of self-management among people living with chronic illness
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
2009 (English)In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824, Vol. 1, no 4, p. 283-293Article 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.

Place, publisher, year, edition, pages
2009. Vol. 1, no 4, p. 283-293
Keywords [en]
chronic disease, self-care, health beliefs, qualitative, Grounded Theory
National Category
Nursing
Identifiers
URN: urn:nbn:se:miun:diva-10456DOI: 10.1111/j.1752-9824.2009.01039.xOAI: oai:DiVA.org:miun-10456DiVA, id: diva2:279066
Projects
Exploring individuals’ conceptions as a way to understand self-managment among people living with long term medical conditionsAvailable from: 2009-12-01 Created: 2009-12-01 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Being creative and resourceful: Individuals’ abilities and possibilities for self-management of chronic illness
Open this publication in new window or tab >>Being creative and resourceful: Individuals’ abilities and possibilities for self-management of chronic illness
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Att vara kreativ och resursstark : Individers förmåga och möjlighet till egenvård av kronisk sjukdom
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. p. 82
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 109
Keywords
Self-management, self-care, chronic illness, chronic disease, qualitative research, life conditions, beliefs and values, self-management integration, longitudinal, Egenvård, sjukdomshantering, kronisk sjukdom, kvalitativ forskning, livsvillkor, värderingar, egenvårds integrering, hantering, anpassning
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-13512 (URN)978-91-86694-39-5 (ISBN)
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

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Audulv, ÅsaNorbergh, Karl-GustafAsplund, Kenneth

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