Support from family and friends is important for our health in so many ways – and especially for those living with a chronic illness, suggests new research.
In its latest Croakey update, the Primary Health Care Research and Information Service (better known as PHC RIS) reports on a new study investigating what factors motivate people with chronic illness to engage in self-management.
As well highlighting the importance of social supports, the study suggests that financial concerns are an important barrier.
How to better support people with chronic illness?
Petra Bywood writes:
With the increasing prevalence of chronic disease in an ageing population, and continuing pressure on the health care workforce, Australian health policy has acknowledged the importance of enhancing health service users’ capacity to engage in self-management. However, motivation is a critical element in successful self-management.
While some research has explored motivation in self-management of specific diseases, little is known about patients’ motivation to self-manage comorbid chronic diseases.
This study aimed to identify motivating factors in chronically ill adults, and suggest policy interventions to enhance motivation to self-manage.
Set in the ACT and Western Sydney, researchers examined patients’ experiences of living with one or more chronic illnesses, including diabetes, chronic obstructive pulmonary disease and/or congestive heart failure. Self-management behaviours were defined as addressing risk factors (e.g., diet and exercise), attending medical appointments and complying with medication and medical advice.
Thematic analyses of study participant interviews revealed a complex web of internal and external motivators and de-motivators that impacted on their self-management behaviours.
The desire to optimise and control their health and maintain independence was a strong internal positive motivator. Participants felt empowered by staying positive and seeking information and support.
However, they were also motivated by negative internal factors, such as the drive to avoid complications, pain and loss of independence. Moreover, a potentially de-motivating factor was the fear of worsening health that was linked to depression or despondency about their condition.
External motivators were also described in both positive and negative terms. Whereas most self-management interventions focus on individuals, this study identified the importance of friends, family and health care professionals to motivate chronically ill patients to self-manage.
However, while most participants were positively motivated by family and friends’ encouragement to ‘do the right thing’ in terms of self-management, others found it a source of irritation or “nagging”.
External de-motivating factors included financial barriers to accessing appropriate care (eg, exercise equipment, special dietary foods, dental or other allied health care).
Although it is generally accepted that motivation is linked to health-related behaviour, people’s level of motivation may fluctuate over time, swinging between motivation and de-motivation, and may be influenced by multiple sources simultaneously.
The challenge for policy interventions is to address de-motivating factors, such as financial concerns.
Suggested options included subsidising self-management by introducing Medicare-supported dental and allied health services; and reduced co-payments for people on low incomes.
• Petra Bywood is Research Manager of the Primary Health Care Research & Information Service
Jowsey T, Pearce-Brown C, Douglas KA, Yen L (2011). What motivates Australian health service users with chronic illness to engage in self-management behaviour? Health Expectations, doi: 10.1111/j.1369-7625.2011.00744.x
This article features in the 8 December 2011 edition of PHC RIS eBulletin, available at http://www.phcris.org.au/publications/ebulletin/index.php.
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