Wednesday, June 22, 2005

Expert Patient: Chronic Disease Management for the 21st Century Patient; Part #3 - WHAT?

OK, after MANY HOURS of Internet research, comes this blog on What is "Chronic Disease Self-Management" all about? Next time, in Part #4, we'll cover the HOW. If you are interested in this concept, where can you find out more about the concept (in general), and actual programs in "your neck of the woods".

Chronic Disease Self-Management; Self-Efficacy; great terms, but what do they really mean?

Consider the following quotations associated with these concepts.
1) "Row Your Own Boat" - Chronic Disease Self-Management.
2) Every bird flies with its own wings." Swahili proverb

What do the two quotations have in common? First of all, the desire, then the knowledge, then the action to take back control over your health, and your life.

Here are questions that you can use to ask yourself about your "readiness" to adopt the concept of Chronic Disease Self-Management (or, to assist someone else in their journey toward this objective).

How confident are you that you can keep the (situation addressed in the question) caused by your disease from interfering with the things you want to do? (Note: this is the "short" test; the longer one contains multiple sub-sections. If anyone wants me to add to this blog the complete set of tests, just ask as a comment to this blog, and I'd be happy to do so.)

For each of the following questions, please choose the number (between 1 and 10) that corresponds to how confident you are that you can keep the symptoms caused by your disease from interfering with the things you want to do? #1 represents "Not at all confident"; #10 represents "Totally confident".

1) How confident are you that you can keep the fatigue caused by your disease from interfering with the things you want to do?
2) How confident are you that you can keep the physical discomfort or pain of your disease from interfering with the things you want to do?
3) How confident are you that you can keep the emotional distress caused by your disease from interfering with the things you want to do?
4) How confident are you that you can keep any other symptoms or health problems you have from interfering with the things you want to do?
5) How confident are you that you can do the different tasks and activities needed to manage your health condition so as to reduce your need to see a doctor?
6) How confident are you that you can do things other than just taking medication to reduce how much you illness affects your everyday life?

The higher you score toward "10" on each question, the more "self-efficacy" you have. (Reminder: self-efficacy is the belief in one's capabilities to organize and execute the sources of action required to manage situations.) As you can probably figure out, I score either 9 or 10 on each question. My Disabilitykey Workbook (see and the confidence that I received by first, executing the processes contined there-in for myself, and then in developing the Workbook to assist others, has allowed my self-efficacy to be high.

OK, you have rated yourself, and you want to know more about the WHAT of this topic. First, we will discuss the definition of Chronic Disease Self-Management; next, the stages of a "chronic disease self-help behavioral change"; and, finally, something called "social learning theory".

Definition of Chronic Disease Self-Management
Based on a comprehensive literature review of over 400 articles, Researchers have proposed the following definition.

Chronic disease self-management involves [the person with the chronic disease] engaging in activities that protect and promote health, monitoring and managing of symptoms and signs of illness, managing the impacts of illness on functioning, emotions and interpersonal relationships and adhering to treatment regimes. There are a number of key elements to this definition that will enable us to develop a practical concept of self-management. It is important to note that these elements are about the behaviors of the patient, rather than models of self-management for health care systems, service providers or health professionals. These elements suggest that self-management:
• Entails engaging in activities that promote health;
• Involves managing a chronic condition by monitoring signs and symptoms;
• Entails dealing with the effect of a chronic condition on personal well being and interpersonal relationships; and
• Involves following a treatment plan prescribed to you by your Doctor(s).

The definition of self-management encompasses a range of behaviors, as well as knowledge and attitudes and is an important starting point towards the development of a concept of chronic disease self-management.

Stages of Behavioral Change
A model of behavior change that has been applied to chronic disease self-management is based on research on how people change behavior, either on their own or within an intervention program (i.e., some sort of action to assist in the change). The theory is that the ceasing of risk behaviors (eg. smoking) and acquisition of health promoting behaviors (eg. physical activity, relaxation) involves the progression through the stages of change. They are:
• Pre-contemplation [not thinking of change]
• Contemplation [thinking of change]
• Determination [ taking preliminary steps to change]
• Action [ actively engaging behavior change]
• Maintenance [ sustained behavioral change]
• Relapse [ can occur at any point.]

Behavioral change is facilitated by a personal sense of control. If people believe that they can take action to solve a problem, they become more inclined to do so and feel more committed to this decision. This "can do" attitude mirrors a sense of control over one's environment. It reflects the belief of being able to master challenging demands by means of adaptive action. It can also be regarded as an optimistic view of one's capacity to deal with stress. (Not to sound redundant, but this really is about the glass being "half-full" and NOT "half-empty".)

Social Learning
OK; now we understand the behavioral change steps; now, on to the social learning stage. The theoretical underpinning of effective chronic disease self-management programs should be based on social learning and behavioral theories. The key principles of these theories as applied to chronic disease self-management are:
• Disease management skills are learned and behavior is self-directed; • Motivation and confidence (including self-efficacy) in managing one's condition dictate an individual's success;
• The social environment (ie. family, workplace & health care system) support or impede self-management; and
• Monitoring and responding to changes in disease state, symptoms, emotions and functioning improve adaptation to the chronic condition.

CONGRATULATIONS! You have managed to get through the information comprising the "WHAT". Next, in part #4, we'll discuss the "HOW".


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