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

Discussion

Being chronically ill is not a 'one moment stressful life event', but a continuous process of balancing the demands of the illness and the demands of everyday life. The basic assumption of this study was that performing self-management activities is more complicated when people have basic and social problems in their everyday life. This study shows that having everyday problems is indeed related to lower levels of self-management. The effect of everyday problems on self-management depends on the type of problems people with chronic illness encounter on a daily basis, as well as on the type of self-management at stake.

One third of the people with chronic illness encounters basic or social problems in their everyday life. Interestingly, having everyday problems is negatively associated with age. Studies show that older adults' lives are less stressful compared to the lives of middle-aged adults, as they report fewer daily stressors and their routines are less disrupted by stressors.[27–29] Furthermore, people with chronic illness are more likely to experience everyday problems when they have physical limitations and when they perceive their health as poor. This is not surprising as some everyday problems might be a direct consequence of having a chronic illness. For instance, people might have problems with their work because of a limited amount of energy due to the chronic illness.

In line with our first hypothesis, the level of recognition and management of symptoms was lower when people have social problems in their daily life. However, in contrast to what we expected, people who had basic problems, such as financial, housing or work problems, did not display a lower level of symptom management than people who did not have those problems. The reason why only social problems were associated with symptom management may be related to the nature of social problems. Having social problems could be a sign of a lack of social support. Studies have shown that good social support has a positive effect on self-management.[30]

In contrast with our second hypothesis, having basic or social problems in everyday life did not have an (small) effect on the level of active involvement in the treatment, such as adhering to treatment regimens, visiting healthcare providers and participating in decision-making. Almost all respondents scored really high on this aspect of self-management, which might indicated that we only measured a basic level of active involvement. In addition, active involvement in treatment will be established in a medical context in close collaboration with healthcare professionals. Therefore, active involvement will not only depend on the patient, but also on the healthcare professional. This probably more easily activates a frame where managing the chronic illness in this respects gets priority.

Finally, we found that having basic and social problems was related to less coping with the consequences of having a chronic illness, such as dealing with the effects of being chronically ill on physical, emotional and social wellbeing. In line with our third hypothesis, coping (from all three self-management dimensions we assessed) appeared to be most affected by having everyday problems. In addition to their negative main effects, having both basic and social problems accumulated in an even lower level of coping. This is an important finding as it might explain why a person with a chronic illness is not able to accept the chronic illness or make the desired lifestyle changes.

Strengths, Limitations and Future Research

A strength of this study is the use of data from a nationwide representative sample of people with chronic illness. This provides unique insights into the perceptions of people with chronic illnesses. In addition, this study is one of the first to examine the effect of everyday problems on the level of self-management of people with chronic illness. We did so by using PSM.

A limitation of this study is that its cross-sectional design means we cannot determine causality; PSM is only an approximation. We aimed to study whether and how everyday problems of people with chronic illness interfere with their self-management, but we cannot reject the reversed effect, namely that poor self-management of a chronic illness results in experiencing (more) everyday problems. We have tried to minimise the problem by using PSM. Another limitation is formed by the fact that we lacked information about the severity of the problems. People could have, for instance, minor financial problems (not being able to go on holiday) or major financial problems (struggling to get by each month). Despite this lack of information about the severity of the problems, we did find a negative association with the level of self-management. This negative association might have been even stronger if we could have included the severity of the problems people with chronic illness encounter. Finally, there are some other socio-demographic characteristics, next to age, gender and highest level of education, that could have influenced both self-management behaviour and having everday problems, such as family arrangements and income. Further research should take those characterisics also into account.

Longitudinal studies are needed to establish whether and in what way everyday problems result in lower levels of self-management. Further research should examine more precisely which types of everyday problems have an effect on self-management and whether combinations of certain problems have an accumulating effect on self-management. Also, the theoretical idea that people set priorities in which problems to address, given their limited resources, and that these priorities are influenced by how they see their personal situation, needs more research.

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