Self-management of illness in adults

This chapter describes the evolution of work in self-care from a site-specific effort to understand a specific intervention designed for a single group of adult patients to a worldwide collaborative effort involving patients with a wide variety of illnesses. Self-care maintenance reflected primarily adherence to treatments and lifestyle recommendations intended to maintain physiologic stability. Individuals with multiple comorbid conditions report difficulty differentiating heart failure (HF) symptoms from those of other conditions and lack confidence in their ability to implement treatment. Cultural beliefs and social norms that vary by ethnic group influence day-to-day decisions about both self-care maintenance and management practices. Gender-specific differences in self-care behaviors are minimal. Individuals who lack situational skill were at risk for poor self-care management. The chapter outlines an intervention that integrates skills-based education with motivational interviewing (MI) to improve HF self-care. Helping patients to become experts in self-care is the focus of future work.