title: Chronic illness: the process of integration.
abstract: OBJECTIVE
  The aim of this study was to explore how adults with a chronic illness integrate the illness experience into their life context.
  
  
  BACKGROUND
  Adults with chronic illnesses are challenged to learn self-management strategies to prevent complications and achieve an acceptable quality of life. Integration represents the process undertaken by an individual to achieve a sense of balance in self-managing a chronic illness and living a personally meaningful life.
  
  
  METHODS
  A mixed-method descriptive design was employed to recruit English-speaking adults with a chronic illness. A semi-structured interview was completed, transcribed verbatim and content analysed. Descriptive data were collected on demographics, co-morbidity and depressive symptoms. The research was undertaken in Connecticut, USA.
  
  
  RESULTS
  The sample (n = 26) was diverse with respect to age (25-80 years), education (8-24 years), duration of illness (1-39 years), gender (63% female) and ethnicity (63% white). Participants reported a mean of four chronic illnesses and 31% of the sample had increased depressive symptoms. The process of integration was complex and multifactorial. Themes of integration included: shifting sands, staying afloat, weathering the storms, rescuing oneself and navigating life. Numerous factors including treatment side effects, a progressive or uncertain illness trajectory, co-morbidity, bad days, financial hardships and interpersonal/environmental challenges contributed to a disruption or difficulty in the integration process.
  
  
  CONCLUSIONS
  All participants made considerable effort to integrate the illness into their life context and participate in a personally meaningful life. However, it was easy to be consumed with 'living an illness' as the daily tasks, the changing symptoms and the fluctuating emotions could be overwhelming. There was a complex co-existence between 'living a life' and 'living an illness'.
  
  
  CONCLUSIONS
  There were numerous challenges to the process of integration and ongoing self-management, psychosocial, vocational and existential support appears indicated, particularly with individuals with multiple chronic illnesses, progressive chronic illnesses and limited resources.
authors.affiliation: Yale School of Nursing, New Haven, CT 06536-0740, USA. robin.whittemore@yale.edu
authors.forename: Robin
authors.initials: R
authors.lastname: Whittemore
authors.forename: Jane
authors.initials: J
authors.lastname: Dixon
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D002908:Chronic Disease / Q000517:prevention & control / Q000523:psychology*; D003237:Connecticut; D017281:Cost of Illness; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007400:Interprofessional Relations; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D015404:Nursing Methodology Research; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology; D012648:Self Care / Q000379:methods / Q000523:psychology*; D012649:Self Concept; D012803:Sick Role; D012944:Social Support; D011795:Surveys and Questionnaires