School of Nursing, University of Wisconsin-Madison, 701 Highland Ave., Madison, WI, 53705, United States.
Int J Nurs Stud. 2018 Jul;83:83-90. doi: 10.1016/j.ijnurstu.2018.04.009. Epub 2018 Apr 13.
Effective self-management in individuals with multiple chronic conditions is necessary to optimize health outcomes. Self-management in multiple chronic conditions involves an iterative process prioritizing multiple changing needs/conditions. However, self-management in multiple chronic conditions has been assessed with instruments designed to assess self-management of a single chronic illness. The instruments may not address the complexity of self-management in multiple chronic conditions. Thus, this review aimed to examine how self-management has been operationalized in the context of multiple chronic conditions.
A narrative review method was used.
The online databases, Pubmed, CINAHL Plus, and PsycInfo, were searched. The search was conducted of the database from January 2006 through November 2017.
Peer-reviewed research articles which operationalized self-management in adults with at least two or more chronic illnesses were selected for review. Two reviewers read full text of selected articles and extracted data regarding operational definitions of self-management and instruments used to assess self-management. Operational definitions were categorized to conceptualize how self-management has been assessed.
A total of seven peer-reviewed research articles were selected for inclusion. This review found that self-management has been assessed through prerequisites of self-management and behaviors involved in self-management. Prerequisites of self-management included attitude, self-efficacy, perceived ability, and knowledge. Behaviors included an individual's engagement in self-management such as health-related behaviors, health service use, and medication adherence.
This review revealed that current literature does not operationalize self-management in multiple chronic conditions as a process, indicating incomplete assessments of self-management. To obtain a more comprehensive understanding of self-management in multiple chronic conditions, future studies should consider self-management as an iterative process in addition to prerequisites for self-management and behaviors. Such studies will inform the development of patient-centered self-management interventions for individuals with multiple chronic conditions.
在患有多种慢性病的个体中进行有效的自我管理对于优化健康结果是必要的。多种慢性病的自我管理涉及一个迭代过程，该过程优先考虑多种不断变化的需求/状况。然而，多种慢性病的自我管理是用设计来评估单一慢性病的自我管理的工具进行评估的。这些工具可能无法解决多种慢性病自我管理的复杂性。因此，本综述旨在检查自我管理在多种慢性病背景下是如何运作的。
采用叙述性综述方法。
在线数据库 Pubmed、CINAHL Plus 和 PsycInfo 进行了搜索。搜索是从 2006 年 1 月到 2017 年 11 月在数据库中进行的。
选择了同行评议的研究文章，这些文章将自我管理应用于至少有两种或多种慢性病的成年人中。两位评审员阅读了选定文章的全文，并提取了关于自我管理的操作定义和用于评估自我管理的工具的数据。对操作定义进行了分类，以概念化自我管理的评估方式。
共选择了 7 篇同行评议的研究文章纳入本研究。本综述发现，自我管理是通过自我管理的先决条件和自我管理中涉及的行为来评估的。自我管理的先决条件包括态度、自我效能感、感知能力和知识。行为包括个人参与自我管理，如与健康相关的行为、卫生服务的利用和药物的依从性。
本综述表明，目前的文献没有将多种慢性病的自我管理作为一个过程来操作化，这表明对自我管理的评估不完整。为了更全面地了解多种慢性病的自我管理，未来的研究应将自我管理视为一个迭代过程，除了自我管理的先决条件和行为。这些研究将为多种慢性病患者提供以患者为中心的自我管理干预措施。
