Pediatric self-management: a framework for research, practice, and policy.
Self-management of chronic pediatric conditions is a formidable challenge for patients, families, and clinicians, with research demonstrating a high prevalence of poor self-management and nonadherence across pediatric conditions. Nevertheless, effective self-management is necessary to maximize treatment efficacy and clinical outcomes and to reduce unnecessary health care utilization and costs. However, this complex behavior is poorly understood as a result of insufficient definitions, reliance on condition-specific and/or adult models of self-management, failure to consider the multitude of factors that influence patient self-management behavior, and lack of synthesis of research, clinical practice, and policy implications. To address this need, we present a comprehensive conceptual model of pediatric self-management that articulates the individual, family, community, and health care system level influences that impact self-management behavior through cognitive, emotional, and social processes. This model further describes the relationship among self-management, adherence, and outcomes at both the patient and system level. Implications for research, clinical practice, and health care policy concerning pediatric chronic care are emphasized with a particular focus on modifiable influences, evidence-based targets for intervention, and the role of clinicians in the provision of self-management support. We anticipate that this unified conceptual approach will equip stakeholders in pediatric health care to (1) develop evidence-based interventions to improve self-management, (2) design programs aimed at preventing the development of poor self-management behaviors, and (3) inform health care policy that will ultimately improve the health and psychosocial outcomes of children with chronic conditions.
Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. avani.modi@cchmc.org
Avani C
AC
Modi
Ahna L
AL
Pai
Kevin A
KA
Hommel
Korey K
KK
Hood
Sandra
S
Cortina
Marisa E
ME
Hilliard
Shanna M
SM
Guilfoyle
Wendy N
WN
Gray
Dennis
D
Drotar
D000293:Adolescent; D017028:Caregivers / Q000193:education / Q000523:psychology; D002648:Child; D002908:Chronic Disease / Q000523:psychology / Q000534:rehabilitation*; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology / Q000628:therapy; D004522:Educational Status; D019317:Evidence-Based Medicine / Q000458:organization & administration; D054541:Family Conflict / Q000523:psychology; D015438:Health Behavior; D006302:Health Services Research; D006801:Humans; D010349:Patient Compliance / Q000523:psychology; D011340:Problem Solving; D012648:Self Care / Q000379:methods / Q000523:psychology; D012944:Social Support; D012959:Socioeconomic Factors