How general practitioners perceive and assess self-care in patients with multiple chronic conditions: a qualitative study

Abstract

BackgroundIt is not known how general practitioners (GPs) perceive the concept of self-care and how they assess self-care ability in patients with multiple chronic conditions. As a part of the strategy to improve the care of people living with chronic conditions, disease management programs in Denmark require GPs and other health care workers to assess and support patients’ self-care ability. The aim of the present study was to explore GPs’ perceptions and assessment of self-care ability in patients with multiple chronic conditions who have difficulty following a given treatment.MethodsA qualitative study conducted through in-depth, semi-structured interviews with a purposive sample of 12 GPs in rural areas of Denmark with economically disadvantaged populations. The interviews involved 36 complex patient cases selected by the GPs themselves. Our analysis followed the principles of systematic text condensation.ResultsMost GPs in our study had a health-related perception of self-care, but some had a broader perception encompassing the situational context of the patient’s life. The GPs’ assessments of patients’ self-care ability were based on information from the ongoing and often long-term relationships with the patients. GPs identified four major factors that influenced patients’ self-care ability, which accumulated and fluctuated over time: multimorbidity, cognitive resources, material resources, and the patients’ social contexts.ConclusionsThe GPs in this study had dual perceptions of self-care, related to both the chronic health conditions and to the broader situational contexts of their patients’ lives. GPs’ assessments of self-care ability depended largely on their experiences from the doctor-patient relationship, and they emphasized that the factors affecting self-care ability were highly dynamic over the patient’s lifetime. However, these findings might be resisted by the Danish disease management programs, which tend to have a static and more narrow, health-related view of patient self-care. The Danish programs require GPs to assess self-care ability upfront at the beginning of treatment and do not consider whether a relationship with the patient is established. If GPs’ perceptions and assessments of self-care ability are not included in chronic disease management models, there is a risk that they vill be insufficiently implemented in general practice.

Development and initial testing of the self‐care of chronic illness inventory

“…Areas that needed the most discussion were items related to physical activity, smoking, and stress management. It was difficult to formulate these items in a way that was congruent with existing evidence while still being applicable to a wide range of chronic conditions (Kristensen, Holge-Hazelton, Waldorff, & Guassora, 2017). For example, recommendations for exercise differ for people seeking to prevent disease (e.g., exercise 30 minutes a day) and those with chronic illness such as heart failure (Evangelista, Cacciata, Stromberg, & Dracup, 2017).…”

Determining the Consequences of Perceived Self-Care Ability in Stroke Patients Living at Home: A Qualitative Study in Iran

“…Researchers believe that patients with high perceived selfcare ability are able to understand their disease and know how to cope with it. Individuals with high perceived selfcare ability can take the necessary measures in the event of any changes (8). Folden showed that the improvement of self-care skills can help a person cope with functional disabilities; therefore, the sustainability of stroke rehabilitation and self-care skills is important (11).…”

“…Generally, the quality of provided care in hospitals is much higher than that provided at home (7). Therefore, attention to self-care in patients with chronic diseases and their participation in self-care activities are essential for disease management (8). Moreover, understanding the patient's self-care ability is important for determining his/her needs during discharge.…”

Definition of the perceived self-care ability in stroke survivors living at home in the Middle East : a protocol for a Systematic Literature Review

“…Management refers to what patients do daily. Self-care comprises the activities and actions carried out by patients on their own [6].…”

“…There are some similarities, overlaps, and differences between the concept of the perceived self-care ability and other concepts such as selfmanagement, self-monitoring, self-efficacy, self-confidence, self-care maintenance, supportive self-4 management, self-maintenance, disease management, and symptom management, which make such concepts interchangeable [14]. Over time, self-care and its related concepts have evolved, and somewhat different definitions have been proposed based ondifferent priorities of the field vis-à-vis the provision of health, therapeutic, and care services [6]. However, the multiplicity of definitions has led to some misinterpretations, and thus, there is an ever-growing need to identify and present these concepts.…”