title: The Influence of Adult Attachment on Patient Self-Management in Primary Care--The Need for a Personalized Approach and Patient-Centred Care.
abstract: OBJECTIVE
  Self-management strategies are essential elements of evidence-based treatment in patients with chronic conditions in primary care. Our objective was to analyse different self-management skills and behaviours and their association to adult attachment in primary care patients with multiple chronic conditions.
  
  
  METHODS
  In the apricare study (Adult Attachment in Primary Care) we used a prospective longitudinal design to examine the association between adult attachment and self-management in primary care patients with multimorbidity. The attachment dimensions avoidance and anxiety were measured using the ECR-RD. Self-management skills were measured by the FERUS (motivation to change, coping, self-efficacy, hope, social support) and self-management-behaviour by the DSMQ (glucose management, dietary control, physical activity, health-care use). Clinical diagnosis and severity of disease were assessed by the patients' GPs. Multivariate analyses (GLM) were used to assess the relationship between the dimensions of adult attachment and patient self-management.
  
  
  RESULTS
  219 patients in primary care with multiple chronic conditions (type II diabetes, hypertension and at least one other chronic condition) between the ages of 50 and 85 were included in the study. The attachment dimension anxiety was positively associated with motivation to change and negatively associated with coping, self-efficacy and hope, dietary control and physical activity. Avoidance was negatively associated with coping, self-efficacy, social support and health care use.
  
  
  CONCLUSIONS
  The two attachment dimensions anxiety and avoidance are associated with different components of self-management. A personalized, attachment-based view on patients with chronic diseases could be the key to effective, individual self-management approaches in primary care.
authors.affiliation: Institute of General Practice and Family Medicine, University Hospital, Jena, Germany; Institute of Psychosocial Medicine and Psychotherapy, University Hospital, Jena, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Brenk-Franz
authors.affiliation: Institute of Psychosocial Medicine and Psychotherapy, University Hospital, Jena, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Strauss
authors.affiliation: Institute of General Practice and Family Medicine, University Hospital, Jena, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Tiesler
authors.affiliation: Institute of General Practice and Family Medicine, University Hospital, Jena, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Fleischhauer
authors.affiliation: Department of Psychiatry and Behavioural Sciences, University of Washington, Seattle, United States of America.
authors.forename: Paul
authors.initials: P
authors.lastname: Ciechanowski
authors.affiliation: Institute of General Practice and Family Medicine, University Hospital, Jena, Germany.
authors.forename: Nico
authors.initials: N
authors.lastname: Schneider
authors.affiliation: Institute of General Practice and Family Medicine, University Hospital, Jena, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Gensichen
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D065026:Hope; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009769:Object Attachment; D011320:Primary Health Care; D012648:Self Care / Q000523:psychology*; D020377:Self Efficacy; D012944:Social Support