What’s in a name? Is ‘looking after myself’ the same as ‘self-management’?

Now a popular term, “self-management” describes the actions taken by individuals to manage the impact of chronic conditions on their everyday lives. From a health perspective, self-management requires capacity (the availability of resources, time, knowledge and energy), responsibility (divided between patients and health professionals) and motivation (the willingness of patients to self-manage their illness). However, gaps relating to terminology and practical application are impeding the translation of policy into practice.

In my PhD study, I examined the self-management strategies used by older adults with a diagnosis of moderate depression to optimise their wellbeing. Although 32 older adults opted to participate in my study on self-management, not a single participant used the term to describe their efforts to self-manage their condition. Despite describing actions and interactions that aligned with self-management, they used terms like “looking after myself” or “self-care”. Another study found that the term “self-management” was used interchangeably and/or associated with self-efficacy, patient empowerment, activation, care, self-monitoring and self-governance (1). At a fundamental level, it seems that we are lacking a universal definition of self-management. As a result, it would not be a stretch to suggest that self-management may not be as universally promoted in practice as policy makers might think. From the patient’s perspective, if they do not even use the term, how can they access the support and services that may help them to manage their illness? Clearly, a basic understanding of self-management terms and concepts would be helpful to individuals, significant others and service providers. And given the prevailing focus on person-centred care and consumer participation, why not ask key stakeholders to suggest their preferred term? For my participants, for example, the term “self-care” resonated more strongly with them than “self-management”.

At the service level interface, self-management policy is also often not being translated into practice. Health professionals are not always fully prepared—in terms of knowledge, skills and/or personal commitment—to support self-management (2). For example, individualised self-management education requires a detailed needs assessment for each person, but current health service models and structures often make collaborative care difficult, as health professionals lack the time and information needed to facilitate knowledge-sharing and decision-making practices associated with effective self-management (3, 4). Current systems of care also frequently lead to the disempowerment of patients, rather than facilitating better engagement and health outcomes (3).

Participants in the current study reported that their discussions with their health professional had not focused on self-management, or self-management education. Without tailored self-management support, they were left to develop their own overall management plans, as they combined information and support from different sources. It is opportune to identify and support self-management strategies that are likely to be helpful to the individual, while providing the best possible outcomes from a health system with limited resources.

About the Author

Meg Polacsek is a PhD Candidate with the College of Health and Biomedicine at Victoria University. Her research explores how older adults with depression self-manage their illness in order to optimise wellbeing. She can be contacted at meg.polacsek@live.vu.edu.au and more information about her research is available at http://www.megsresearch.com/home.  

References

1. Ellis J, Boger E, Latter S, Kennedy A, Jones F, Foster C, et al. Conceptualisation of the "good"self-manager: A qualitative investigation of stakeholder views on the self-management of long-term health conditions. Social Science & Medicine. 2017.
2. Holm AL, Severinsson E. Reflections on the ethical dilemmas involved in promoting self-management. Nursing Ethics. 2014;21(4):402-13.
3. Lawn S, Delany T, Sweet L, Battersby M, Skinner TC. Control in chronic condition self‐care management: How it occurs in the health worker–client relationship and implications for client empowerment. Journal of Advanced Nursing. 2013;70(2):383-94.
4. Harris M, Jones P, Heartfield M, Allstrom M, Hancock J, Lawn S, et al. Changing practice to support self-management and recovery in mental illness: Application of an implementation model. Australian Journal of Primary Health. 2015;21(3):279-85.