title: Descriptions of barriers to self-care by persons with comorbid chronic diseases.
abstract: BACKGROUND
  Chronic medical conditions often occur in combination, as comorbidities, rather than as isolated conditions. Successful management of chronic conditions depends on adequate self-care. However, little is known about the self-care strategies of patients with comorbid chronic conditions.
  
  
  OBJECTIVE
  Our objective was to identify perceived barriers to self-care among patients with comorbid chronic diseases.
  
  
  METHODS
  We conducted semistructured personal interviews with 16 adults from 4 urban family practices in the CaReNet practice-based research network who self-reported the presence of 2 or more common chronic medical conditions. Using a free-listing technique, participants were asked, "Please list everything you can think of that affects your ability to care for your medical conditions." Responses were analyzed for potential barriers to self-care.
  
  
  RESULTS
  Participants' responses revealed barriers to self-care, including physical limitations, lack of knowledge, financial constraints, logistics of obtaining care, a need for social and emotional support, aggravation of one condition by symptoms of or treatment of another, multiple problems with medications, and overwhelming effects of dominant individual conditions. Many of these barriers were directly related to having comorbidities.
  
  
  CONCLUSIONS
  Persons with comorbid chronic diseases experience a wide range of barriers to self-care, including several that are specifically related to having multiple medical conditions. Self-management interventions may need to address interactions between chronic conditions as well as skills necessary to care for individual diseases.
authors.affiliation: Department of Family Medicine, University of Colorado Health Sciences Center, Denver, Colorado, USA. elizabeth.bayliss@kp.org
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bayliss
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
authors.forename: Douglas H
authors.initials: DH
authors.lastname: Fernald
authors.forename: Lori A
authors.initials: LA
authors.lastname: Crane
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Main
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012648:Self Care; D014505:Urban Population