The literature suggests that we need to consider the following components in effective management of chronic disease (Wagner et al., 1996):
- Personalised care plans
- Self-management education
- Adherence to treatment
- Follow up and monitoring
The research also suggests that programs that are successful in improving self-management have the following characteristics:
- Goal Setting
Self-management may seem to be a relatively simple concept with very simple elements; it is often equated to an individual taking sole responsibility for their health and chronic condition (i.e., ‘Self-care’). However, the elements of self-management are not as self-evident, and it certainly is not self-care.
Based on a comprehensive literature review of over 400 articles, Gruman and Von Korff (1996) have proposed the following definition:
Self-management “Involves [the person with the chronic condition] 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” (p1).Kate Lorig (1993) one of the leading researchers in this area adds that self-management is also about enabling:
… participants to make informed choices, to adapt new perspectives and generic skills that can be applied to new problems as they arise, to practice new health behaviours, and to maintain or regain emotional stability.
The following characteristics could therefore be seen to summarise a ‘good’ self-manager and are an important part of the Flinders Program, known as the seven Principles of Self-Management (KICMRILS: Knowledge, Involvement, Care plan, Monitor & Respond, Impact, Lifestyle, Support services).
These Principles of Self-Management refer to the capacity of individuals to:
- Have knowledge of their condition
- Follow a treatment plan (care plan) agreed with their health professionals
- Actively share in decision making with health professionals
- Monitor and manage signs and symptoms of their condition
- Manage the impact of the condition on their physical, emotional and social life
- Adopt lifestyles that promote health
- Have confidence, access and the ability to use support services
Self-management is not an alternative to medical care; rather, it is “aimed at helping the participant to become an active, non adversarial, partner with health care providers. Chronic disease is best treated by a balance of traditional medical care and the day-to-day practice of self-management skills” (Lorig 1993, p.11).
Self-management support is therefore a key role for health providers in the management of chronic conditions. Self-management support is the systematic provision of education and supportive interventions by health care staff to increase clients’ skills and confidence in managing their health problems, including regular assessment of progress and problems, goal setting and problem-solving support.
If you are interested in finding out more about self-management and self- management support for the management of conditions, below are some suggested further readings:
Gruman, J, & Von Korff, M. (1996) Indexed bibliography on Self-management for People with Chronic Disease. Center for Advancement in Health: Washington, DC
Lorig, K. (1993) Self-management of chronic illness: a model for the future (self care and older adults), Generations, 17, 11-14.
Wagner, E., Austin, B., & Von Korff, M. (1996) Organizing Care for Patients with Chronic Illness, The Milbank Quarterly, 74, 511- 542.