Self-Management in Chronic Illness: From Theory to the Practice

Chronic disease is responsible in the world, and particularly in Europe, for much of the mortality and morbidity, it is expected an increase of this scenario in the coming years. Often, chronic disease and its comorbidities, represent the cause of episodes of hospitalization for lack of disease control or its consequences. Intervention core to reduce health costs and promote quality of life is increase capacity for self-management in people with chronic illness.

The study issues on disease management and treatment regimen, as a self-care activities (self-management), assuming that the way the health/disease transition is experienced influences the way the adaptive processes move on, the development of mastery and a fluid identity, that incorporates the disease as part of the "self". In this context, we conceptualize “self-management style” as a synthesis of personality, attitudes and health behaviors.

Purpose: create an intervention model of self-management promotion in persons with chronic illness based on individual style and vulnerability profile.

The aim for this presentation is to disclose the development of the instrument to characterize self-management style.

Methods:  The wider project is developed in three phases:

Phase 1 (ended) - Construction of an explanatory theory about self-management in chronic illness;

Phase 2 - Development of an instrument to characterize self-management style;

Phase 3 (in progress) - Construction and application of a model of intervention and follow up according the self-management style from each client and vulnerability profile.

Protocols with institutional partners were established for longitudinal study’s, aiming to induce specific models of accomplishment according specific diseases and vulnerability profiles.

At this conference we propose to present the explanatory theory as the basis for construction of the tool for self-management lifestyle characterization and vulnerability profile of each client.

This instrument was pre-tested and four researchers evaluated each item for appropriateness, clarity and relevance. Suggestions for change was made, in special, about "how to put the question" on perspective of researcher and  respondents. Finaly a consensus version was obtained on a focus group, with seven experts.

  Results: As self-management grounded theory identifies the categories, their properties and dimensions and, supporting by Nursing Outcomes Classification (NOC), the instrument had three different parts:

1. Identity traits and attitudes towards illness and treatment regimen questionnaire. This part of questionnaire had forty-five items, and identifies personal features and different ways of living with the disease.
2. Self-report perception of behavior towards the therapeutic regimen. Thirteen items indicate different behaviors related to the treatment of disease.
3. Self-management style characterization questionnaire in nurses perception. Fifteen items clarify different behaviors related to how each client manage his therapeutic regimen.

The scale ranges from 1 to 5 for strongly disagree to strongly agree.  

Conclusion:  This instrument is ready to be applied to contribute to greater positive discrimination based on personal characteristics and therefore the appropriateness of therapeutic nursing intensity and intentionality that allows them to be more significant for people with chronic disease.The instrument is being implemented expeditiously, taking on average about twenty minutes, is well accepted by customers and nurses. Suggests clinical application and known results suggest good internal consistency.