Research ArticleResearch

Challenges of self-management when living with multiple chronic conditions

Systematic review of the qualitative literature

Clare Liddy, Valerie Blazkho and Karina Mill
Canadian Family Physician December 2014; 60 (12) 1123-1133;

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Flow diagram: Articles retrieved through search up to September 30, 2013.

  • Figure 2.
    Figure 2.

    Hudon and colleagues’ conceptual framework of patient-centred care

    Data from Hudon et al.25

  • Figure 3.
    Figure 3.

    Common themes found in thematic synthesis as reported through the lens of Hudon and colleagues’ conceptual framework of patient-centred care

    Adapted from Hudon et al.25

Tables

  • Table 1.

    Characteristics of publication examining the perspectives of patients living with multiple chronic conditions

    STUDYDESIGNSAMPLE SIZEFEMALE SEX, %AGE, YOBJECTIVESCOUNTRYCONDITIONS
    Bayliss et al,7 2003Qualitative study, semistructured personal interviews1681Range 31–70Identify perceived barriers to self-care among patients with comorbid chronic diseasesUS2 or more common chronic conditions (4.3 on average)
    Noël et al,8 2007Cross-sectional survey72010Median 57Examine the self-management learning needs and willingness to see nonphysician providers of patients with multimorbidity compared with patients with single chronic illnessesUSMultiple chronic conditions vs single condition
    Bair et al,28 2009Qualitative study using focus groups1861Range 27–84Identify barriers and facilitators to self-management of chronic musculoskeletal pain among patients with comorbid pain and depressionUSPain, comorbid depression
    Bayliss et al,29 2008Qualitative investigation2650Range 65–84Explore processes of care desired by elderly patients who have multimorbidities that might present competing demands for patients and providersUSDiabetes, depression, or osteoarthritis (4–16 comorbidities)
    Roberto et al,30 2005Qualitative analysis17100Range 69–84Examine the health care practices and management strategies used by 17 older women with multiple chronic conditionsUSHeart disease and diabetes; heart disease and osteoporosis; or all 3
    Jowsey et al,31 2009Semistructured interviews and focus group5246Range 45–85Identify the common challenges comorbidity poses to patients and caregivers in their experiences of self-management, detail the views and perceptions of health professionals about these challenges, and discuss policy options to improve health care for people with comorbid chronic illnessAustralia1 or more of diabetes, COPD, or CHF
    Noël et al,32 2005Focus groups using a series of open-ended questions6020Range 30–80Explore the collaborative care needs and preferences in primary care patients with multiple chronic illnessesUS2 or more chronic illnesses
    Bardach et al,33 2011One-on-one interviews4271Mean 63, range 51–76Explore how vulnerable rural residents described social support in the context of self-management for multiple chronic conditionsUSAll patients with multiple chronic conditions
    Beverly et al,34 2011Qualitative study, focus groups3256Range 60–88Explore older patients’ perceived effects of chronic comorbid conditions on type 2 diabetes self-managementUSType 2 diabetes and 1 or more other conditions
    Dickson et al,35 2011Qualitative descriptive meta-analysis techniques9934Mean 59.6Explore how comorbidity influences heart failure self-careUSHeart failure and at least 1 comorbid condition
    Townsend et al,36 2003Qualitative longitudinal study with in-depth interviews every 5 y2357Range 53–58Examine attitudes toward drug use among middle-aged respondents with high levels of chronic morbidityScotland4 or more chronic conditions
    Townsend et al,37 2008Qualitative longitudinal study with in-depth interviews every 5 y2357Range 58–63Investigate reasons for frequent consultation among people with multiple morbidity but contrasting consulting ratesScotland4 or more chronic conditions
    Bayliss et al,38 2007Cross-sectional telephone survey35265Range 65–74Identify barriers to self-management that were associated with lower perceived health status and, secondarily, with lower reported physical functioning for a population of seniors with multimorbiditiesUSAverage 8.7 chronic medical conditions
    Corser and Dontje,39 2011Qualitative study1878Mean 63.7, range 34–83Explore the perceived health care needs of adults with numerous comorbid conditions by focusing on their self-management practices and relationships with primary care providersUSAt least 4 comorbid conditions
    Loeb,40 2006Focus group2869SeniorsIdentify strategies used by community-dwelling elderly African American patients to cope with their chronic health conditionsUSPatients with at least 2 chronic conditions (a total of 14 different types of conditions among patients)
    Morris et al,41 2011Longitudinal qualitative study using semistructured interviews2148Mean 93, range 36–84Examine what influences self-management priorities for individuals with multiple long-term conditions and how this changes over timeUK2 or more conditions, (must have 1 of IBS, COPD, or diabetes)
    Schoenberg et al,42 2011Qualitative study, 3-stage in-depth interview2085Mean 55, range 41 and aboveImprove understanding of the ways in which vulnerable, rural residents experience and manage multiple morbidityUSAverage of 4 chronic, self-reported health conditions (including hypertension, arthritis, type 2 diabetes, cancer, stroke, and numerous others)
    Sells et al,43 2009Qualitative, longitudinal retrospective study; semistructured interviews with 3 questionnaires3370Mean 50.5Describe and better understand adults’ responses to the onset, accrual, and influence of multiple chronic conditions and to social support in adapting to consequent difficultiesUSAll participants carried multiple medical diagnoses
    Whittemore and Dixon,44 2008Mixed-method descriptive design, semistructured interview2663Range 25–80Explore how adults with a chronic illness integrate the illness experience into their life contextsUSAverage of 4 comorbidities (most participants had more than 1 chronic condition)
    Schoenberg et al,45 2009In-depth interviews4185Mean 70.4, range 55–90Investigate which comorbidities older adults prioritize, why, and how they accommodate these conditions, focusing on elderly patients with 2 or more chronic conditions and low socioeconomic statusUSHypertension, arthritis, and diabetes
    Leach and Schoenberg,46 2008Interview, qualitative data4185Range 55–84Increase understanding of how older adults attempt to manage multiple morbidities and retain control of their healthUSHigh blood pressure, arthritis, diabetes
    Warren-Findlow and Prohaska,47 2008Qualitative study with multiple in-depth interviews conducted over 2 y12100Mean 62, range 50–73Describe the specific type and extent of social support provided by family members to older African American women managing chronic diseaseUSIn addition to heart disease, participants self-reported having other chronic illnesses: hypertension, arthritis, obesity, gastroesophageal reflux disease, asthma, sleep apnea, and diabetes
    Sakraida and Robinson,48 2009Semistructured focus groups1250Mean 58Describe the transition and self-management experiences of patients diagnosed with type 2 diabetes mellitus and stage 3 chronic kidney diseaseUSType 2 diabetes and stage 3 chronic kidney disease

    • CHF—congestive heart failure, COPD—chronic obstructive pulmonary disease, IBS—irritable bowel syndrome, UK—United Kingdom, US—United States.

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Challenges of self-management when living with multiple chronic conditions
Clare Liddy, Valerie Blazkho, Karina Mill
Canadian Family Physician Dec 2014, 60 (12) 1123-1133;
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