Self-management as a Healthcare Concept
Erin Martz, Ph.D.
Chronic health conditions are health issues that require ongoing management for many years or even decades. They are responsible for the majority of deaths world-wide, according to the World Health Organization. And as people are living longer, the prevalence of chronic health conditions and expenditures on chronic condition healthcare continue to rise. What can healthcare professionals do to prepare for the climbing numbers of people who need help with chronic health conditions?
One answer to this question is self-management, which is the managing of one’s chronic health condition in collaboration with a healthcare provider. For years, self-management has been defined in terms of three components related to one’s chronic health condition: Medical management (e.g., taking medication as prescribed); behavioral management (adapting one’s life around the condition and its limitations); and emotional management (dealing with emotional reactions to having a chronic health condition). These three components can influence health-related outcomes while living with a chronic health condition. Healthcare professionals, including medical, mental health, and rehabilitation professionals, may provide guidance about these components. But ultimately, once the person walks out of the office door, the health outcomes will depend on how the individual decides to implement the advice and treatment protocols that they have been given by healthcare providers.
Clinicians helping individuals with chronic conditions like arthritis, diabetes, pain, HIV, cardiac conditions, and multiple sclerosis may face a ‘revolving door’ of need. Medical issues often are not cured, but managed. Most healthcare professionals may try to teach individuals about how to best manage their chronic conditions. Yet, we know from decades of research that health-related education alone is not effective in helping many individuals with chronic conditions maintain the preferred health behaviors. The concept that education alone is not sufficient for encouraging healthy behaviors is one reason why self-management is receiving increasing clinical and research interest.
Individuals with chronic health conditions have to deal with their conditions 24 hours a day, so they need to be taught self-management skills. That means that they are actively managing their own health in the hour by hour, day by day decision-making related to health issues. This can be viewed as micro-management of one’s health. Healthcare professionals help with the macro-management, which involve deciding on the best the types of treatment and defining the parameters of care that individuals need for their particular condition. Collaboration with healthcare providers is expected in the self-management model of chronic conditions. This means individuals need to know what they can expect from professional treatment for their chronic condition and what they are encouraged to do in all other times (i.e., out of the doctor’s office).
Self-management by individuals with chronic health condition is not optional but inevitable, because healthcare professionals only interact with individuals for a small portion of their lives. Individuals must learn how to make micro-decisions related to their conditions by education about the condition and its treatment, but also by encouragement and empowerment to make those micro-decisions outside of the doctor’s office.
Chronic health conditions continue to increase world-wide, with many individuals having multiple health conditions. Self-management concepts can help to provide a roadmap to healthcare professionals in their efforts to help individuals who are trying to deal with the challenge of living with chronic health conditions.