It is not known how general practitioners (GPs) perceive the concept of self-care and how they assess self-care ability in patients with multiple chronic conditions. As a part of the strategy to improve the care of people living with chronic conditions, disease management programs in Denmark require GPs and other health care workers to assess and support patients’ self-care ability. The aim of the present study was to explore GPs’ perceptions and assessment of self-care ability in patients with multiple chronic conditions who have difficulty following a given treatment.
A qualitative study conducted through in-depth, semi-structured interviews with a purposive sample of 12 GPs in rural areas of Denmark with economically disadvantaged populations. The interviews involved 36 complex patient cases selected by the GPs themselves. Our analysis followed the principles of systematic text condensation.
Most GPs in our study had a health-related perception of self-care, but some had a broader perception encompassing the situational context of the patient’s life. The GPs’ assessments of patients’ self-care ability were based on information from the ongoing and often long-term relationships with the patients. GPs identified four major factors that influenced patients’ self-care ability, which accumulated and fluctuated over time: multimorbidity, cognitive resources, material resources, and the patients’ social contexts.
The GPs in this study had dual perceptions of self-care, related to both the chronic health conditions and to the broader situational contexts of their patients’ lives. GPs’ assessments of self-care ability depended largely on their experiences from the doctor-patient relationship, and they emphasized that the factors affecting self-care ability were highly dynamic over the patient’s lifetime. However, these findings might be resisted by the Danish disease management programs, which tend to have a static and more narrow, health-related view of patient self-care. The Danish programs require GPs to assess self-care ability upfront at the beginning of treatment and do not consider whether a relationship with the patient is established. If GPs’ perceptions and assessments of self-care ability are not included in chronic disease management models, there is a risk that they vill be insufficiently implemented in general practice.
Region Zealand. Disease management programme for type 2 diabetes mellitus (Forløbsprogram for Type 2 Diabetes Mellitus) Region Zealand - Denmark; 2011.
The National Board of Health. Chronic disease management - a national strategy. Disease management programmes and self-management support. Copenhagen: The National Board of Health; 2007.
Gron L. Self care - a boundary object in chronic care. Klinisk Sygepleje. 2011;25(4):13–24.
Star SLGJ. Institutional ecology, ‘translations’ and boundary objects: amateurs and professionals in Berkeley’s Museum of Vertebrate Zoology, 1907-39. Soc Stud Sci. 1989;19:387–420. CrossRef
Sorensen K, Van den Broucke S, Pelikan JM, Fullam J, Doyle G, Slonska Z, Kondilis B, Stoffels V, Osborne RH, Brand H. Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health. 2013;13:948. CrossRefPubMedPubMedCentral
Orem DE. Nursing, concepts of practice. 6th ed. St. Louis: Mosby; 2001.
Meleis AI. On needs and self-care. In: Theoretical nursing : development and progress. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2012. p. 207–28.
- How general practitioners perceive and assess self-care in patients with multiple chronic conditions: a qualitative study
Mads Aage Toft Kristensen
Frans Boch Waldorff
Ann Dorrit Guassora
- BioMed Central
Neu im Fachgebiet Allgemeinmedizin
Meistgelesene Bücher aus dem Fachgebiet
Mail Icon II