title: The over time development of chronic illness self-management patterns: a longitudinal qualitative study.
abstract: BACKGROUND
  There currently exists a vast amount of literature concerning chronic illness self-management, however the developmental patterns and sustainability of self-management over time remain largely unknown. This paper aims to describe the patterns by which different chronic illness self-management behaviors develop and are maintained over time.
  
  
  METHODS
  Twenty-one individuals newly diagnosed with chronic illnesses (e.g., diabetes, rheumatism, ischemic heart disease, multiple sclerosis, chronic renal disease, inflammatory bowel disease) were repeatedly interviewed over two-and-a-half years. The interviews were conducted in Sweden from 2006 to 2008. A total of 81 narrative interviews were analyzed with an interpretive description approach.
  
  
  RESULTS
  The participants' self-management behaviors could be described in four different developmental patterns: consistent, episodic, on demand, and transitional. The developmental patterns were related to specific self-management behaviors. Most participants took long-term medications in a consistent pattern, whereas exercise was often performed according to an episodic pattern. Participants managed health crises (e.g., angina, pain episodes) according to an on demand pattern and everyday changes due to illness (e.g., adaptation of work and household activities) according to a transitional pattern. All of the participants used more than one self-management pattern.
  
  
  CONCLUSIONS
  The findings show that self-management does not develop as one uniform pattern. Instead different self-management behaviors are enacted in different patterns. Therefore, it is likely that self-management activities require support strategies tailored to each behavior's developmental pattern.
authors: Department of Health Sciences, Mid Sweden University, SE-851 70 Sundsvall, Sweden. asa.audulv@miun.se
authors: Åsa
authors: Å
authors: Audulv
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000523:psychology* / Q000628:therapy*; D003266:Continuity of Patient Care; D005260:Female; D015438:Health Behavior; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012648:Self Care / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends; D013548:Sweden; D013997:Time Factors
references: Health Serv Res. 2009 Jun;44(3):1068-87
references: 19674433
references: Med J Aust. 2007 Jan 15;186(2):84-7
references: 17223770
references: J Nurs Scholarsh. 2001;33(1):21-6
references: 11253576
references: Osteoporos Int. 2012 Jan;23(1):223-31
references: 21308365
references: J Gerontol B Psychol Sci Soc Sci. 2008 Sep;63(5):S312-9
references: 18818452
references: J Gen Intern Med. 2007 Dec;22(12):1635-40
references: 17647065
references: Arthritis Care Res (Hoboken). 2012 Dec;64(12):1864-70
references: 22740421
references: Br J Community Nurs. 2006 Jan;11(1):6-10
references: 16493291
references: ANS Adv Nurs Sci. 2012 Jul-Sep;35(3):194-204
references: 22739426
references: Qual Health Res. 2003 Dec;13(10):1337-52
references: 14658350
references: Rehabil Nurs. 1997 Jul-Aug;22(4):199-205
references: 9275811
references: J Fam Nurs. 2013 Feb;19(1):3-28
references: 23288886
references: Ann Behav Med. 2003 Aug;26(1):1-7
references: 12867348
references: J Nurs Scholarsh. 2012 Jun;44(2):136-44
references: 22551013
references: Qual Health Res. 2008 May;18(5):606-19
references: 18420535
references: Heart Lung. 2004 Nov-Dec;33(6):345-53
references: 15597287
references: Med J Aust. 2008 Nov 17;189(S10):S21-4
references: 19143586
references: Patient Educ Couns. 2008 Nov;73(2):354-62
references: 18799284
references: Chronic Illn. 2010 Mar;6(1):22-33
references: 20308348
references: Diabet Med. 2009 Jun;26(6):636-40
references: 19538240
references: J Cardiovasc Nurs. 2009 Jan-Feb;24(1):40-7
references: 19114800
references: Implement Sci. 2011 May 29;6:56
references: 21619695
references: Chronic Illn. 2011 Jun;7(2):147-61
references: 21343220
references: Public Health Rep. 2004 May-Jun;119(3):239-43
references: 15158102
references: J Clin Nurs. 2009 Dec;18(23):3308-15
references: 19930088
references: Gen Hosp Psychiatry. 2012 Jul-Aug;34(4):385-9
references: 22554428
references: Int J Health Serv. 2009;39(4):725-47
references: 19927412
references: Diabetes Care. 2000 Jul;23(7):928-33
references: 10895842
references: Res Nurs Health. 1997 Apr;20(2):169-77
references: 9100747
references: Can J Nurs Res. 1996 Winter;28(4):37-56
references: 9128475
references: Qual Health Res. 2012 Mar;22(3):332-45
references: 22167155
references: Osteoporos Int. 2012 Mar;23(3):1053-60
references: 21503813
references: Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005108
references: 17943839
references: Int J Nurs Stud. 2008 Oct;45(10):1525-33
references: 18439609
references: Nurs Res. 2002 Jan-Feb;51(1):18-25
references: 11822565