Understanding the adoption of self -management behavior based on patients' stage of change profiles in chronically ill populations

Jayashri Sankaranarayanan, Purdue University

Abstract

This study involved application of the transtheoretical (TTM) readiness stages of change model to self-management behavior (in the Andersen-Newman Behavioral framework of Health Care Utilization) primarily to understand patients' self-management behavior adoption in chronic medical conditions. The four objectives were to determine the: (1) distribution of self-management readiness stages (TTMSM), its association with chronic medical conditions, and its significance in identifying patient's risk status, and relationship of TTMSM with (2) socio-demographic, and psychosocial (coping, stress, self-efficacy, goal setting) factors, (3) self-management behavior and (4) perceived health outcomes (health status and patient satisfaction). A prospective, cross-sectional random mail survey of 4,040 low-risk and 700 high-risk patient enrollees from an Indiana-based managed care database, was undertaken. The inclusion criteria were patients 18 years and older with asthma, diabetes, hyperlipidemia, or hypertension. The usable net survey response rate was 13 percent. The patients (n = 609) (mean: two chronic conditions, mean disease duration: 14 years, majority wanting self-management advice) distributed across all five TTMSM-stages (pre-contemplation, contemplation, preparation, action, or maintenance) for the three self-management domains of participation with doctor, general, and lifestyle management, but not for the medical care domain. More patients (36.1 percent) were in pre-contemplation and contemplation for general self-management than other self-management behaviors. A significance level of 0.05 was used in statistical analyses. The TTMSM readiness stage for lifestyle management and participation with doctor were significant in classifying a patient as low-risk utilizer. Age, high school and above education, goal setting, self-management behavior, satisfaction with care, and mental health status were significant for patient self-management readiness (adjusted R-square-41.3 percent) while type of chronic medical condition was not. The TTMSM readiness stage for the four self-management domains, were significant for self-management behavior after controlling for clinical (total number and maximum duration of the four medical conditions of interest), psychosocial, and health status (adjusted R-square-48.2 percent) variables. Patient self-management readiness had significant positive association with self-management behavior, which had positive significant association with patient perceived health status. In conclusion, independent of chronic conditions, the TTMSM-readiness stage appears to influence health status through patient self-management behavior. For effective and coordinated delivery in targeting self-management education programs, health providers need to consider patients' TTMSM readiness stage as an independent factor, in addition to their chronic conditions.

Degree

Ph.D.

Advisors

Mason, Purdue University.

Subject Area

Pharmaceuticals|Public health|Behaviorial sciences

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