Do Everyday Problems of People With Chronic Illness Interfere With Their Disease Management?

Lieke van Houtum; Mieke Rijken; Peter Groenewegen

Disclosures

BMC Public Health. 2015;15(1000) 

In This Article

Background

Self-management of (chronic) illness by patients has been promoted by healthcare providers and policymakers in many Western societies as a cornerstone of modern healthcare.[1] Self-management requires people with chronic illness to monitor their health status, take medication as prescribed, interact with healthcare providers and manage the impact of the illness on physical, psychological and social functioning.[2] However, people with chronic illness often find it difficult to perform effective self-management,[3] as indicated by e.g. low rates of medication adherence,[4,5] poor levels of disease control,[6] and the modest positive effects of self-management interventions.[7,8]

Previous studies have shown that people with chronic illness experience tension between managing and controlling their chronic illness while being able to do what they would like to do with their lives.[9–11] As Corbin and Strauss state (1985), the ideal context for self-management would be a controlled environment in which influences of everyday life are minimised.[12] However, in reality, people with chronic illness need to consistently balance the demands of the illness against those of everyday life, as the lives of people do not solely consist of taking care of their chronic illness. People with chronic illness have jobs, partners, children, friends, and hobbies, and experience the delights and concerns that come with them. Moreover, due to their illness they may encounter additional problems in daily life, for instance problems related to living independently (e.g. housing, finances). These problems might be partly the consequence of having a chronic illness, but they might also influence the way people manage their illness.

The Social Production Function theory of Lindenberg and colleagues[13–15] states that people produce well-being by achieving goals, within the set of resources and constraints they face. Based on this theory, we argue that people with chronic illness need to prioritise their goals and decide where their resources such as time, energy, money and social support will go. Facing, for instance, financial, marital or housing problems, people may prioritise coping with these problems as more important than managing their chronic illness. Solving everyday problems requires resources, which can then no longer be used to manage the chronic illness. For example, research of Townsend et al. (2006) indicated that people with chronic illness sometimes gave priority to maintaining a 'normal' life at the expense of controlling symptoms.[11]

"The process of self-management could be eased if the particular circumstances and the broader context in which it takes place are addressed by practitioners".[11] Understanding how everyday life affects self-management might help to provide better support. Most research, however, focuses on how chronic illness complicates maintaining a normal life. Until now, little attention has been paid to the opposite, namely how everyday life influences the level of self-management of people with a chronic illness. Therefore, the purpose of this study is to examine to what extent problems in everyday life intervene with the level of self-management of people with chronic illness.

Hypotheses

To guide our research, we formulated the following hypotheses:

  1. Recognising and managing symptoms of a chronic illness requires time and energy. Examples of symptom management are monitoring of glucose level or blood pressure when you have diabetes or cardiovascular diseases, controlling shortness of breath when you have asthma or COPD, or doing exercises to maintain flexible when you have arthritis. We expect that symptom management will be neglected when people have everyday problems, such as financial, work-related, marital, or social problems, that also require their attention. We therefore hypothesise that experiencing problems in everyday life will be negatively associated with the level of daily symptom management of people with chronic illness.

  2. Being actively involved in the treatment of the illness by adhering to treatment regimens, visiting healthcare providers and participating in decision-making will also require time and energy from people with chronic illness. However, these self-management tasks are more likely to be performed within a medical context, in close collaboration with healthcare professionals. Therefore, we expect that the effect of everyday problems on patients' active involvement in the treatment will be limited. In effect, we hypothesise that experiencing problems in everyday life will be negatively associated with the level of active involvement in treatment of people with chronic illness, but to a lesser extent than their symptom monitoring and management.

  3. Dealing with the consequences of having a chronic illness on physical, emotional and social wellbeing (coping) may be particularly complicated when people also have other problems. We expect that this aspect of self-management will be influenced most, as there are many similarities between having to deal with everyday problems and coping with chronic illness. We therefore hypothesise that experiencing problems in everyday life will be negatively associated with the coping behaviour of people with chronic illness.

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