Self-care and self-management have become increasingly recognized as fundamental components of healthcare, especially for individuals navigating chronic conditions. It’s estimated that a significant majority, over 99%, of daily chronic condition management is handled by individuals themselves and their family caregivers (Riegel et al., 2017). While the terms “self-care” and “self-management” are frequently used, their definitions and conceptualizations often lack consistency, leading to ambiguity in research and practice (Barlow et al., 2002; Grady & Gough, 2014; Matarese et al., 2018; Richard & Shea, 2011; Van de Velde et al., 2019). Despite these definitional nuances, self-management is generally understood as a subset of self-care, specifically within the context of a diagnosed health condition and often involving some level of healthcare provider guidance (Matarese et al., 2018). Van de Velde et al. (Van de Velde et al., 2019, p. 10) define self-management as “the intrinsically controlled ability of an active, responsible, informed, and autonomous individual to live with the medical, role, and emotional consequences of [their] chronic condition(s) in partnership with [their] social network and healthcare provider(s).”
Self-care, conversely, is a broader concept. The World Health Organization (WHO, 2022b) defines it as “the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and cope with or without the support of a healthcare provider.” According to Riegel’s Middle-Range Theory of Self-Care of Chronic Illness (Riegel et al., 2012), self-care encompasses three key dimensions: adherence to treatment and health-promoting behaviors (self-care maintenance), monitoring of health status and conditions (self-care monitoring), and effectively responding to signs and symptoms when they arise (self-care management). Established models like the Chronic Disease Self-Management Program (Lorig et al., 1999), the Chronic Care Model (Wagner et al., 1996), and the Flinders Chronic Condition Management Program (Battersby et al., 2007) all underscore the shared aspects of managing various chronic conditions and are designed to be applicable across diverse populations and diagnoses.
Qualitative research and numerous systematic reviews have consistently demonstrated that self-care and self-management are multifaceted, comprising various skills, attitudes, and abilities crucial for individuals facing the daily realities of chronic conditions (Audulv et al., 2012; Boehmer et al., 2016; Liddy et al., 2014; Schulman-Green et al., 2016; Van de Velde et al., 2019). Specifically focusing on older adults, research has identified key characteristics defining self-care and self-management in the context of chronic conditions and multimorbidity. These include effectively utilizing financial resources for health management, actively seeking health-related education, leveraging social support systems, adapting positively to health changes, maintaining consistent engagement with the healthcare system, and actively participating in the management of their chronic conditions (Garnett et al., 2018). Furthermore, Lawless et al. (Lawless et al., 2021) pinpointed seven core theoretical constructs vital for self-care and self-management in older adults: temporal and spatial context, stressors, personal resources, informal social resources, formal social resources, behavioral adaptations, and quality of life outcomes. A comprehensive assessment of these diverse domains of self-care and self-management is essential. It empowers individuals, caregivers, and healthcare professionals to pinpoint the specific challenges faced by older adults with chronic conditions and multimorbidity. This understanding then facilitates the effective access, delivery, and evaluation of appropriate resources, programs, and support systems.
The Importance of Self-Care Measurement Tools
The development and effective implementation of Self-care Measurement Tools are critical for informing healthcare delivery and demonstrating the efficacy of various programs, policies, and interventions (Nichols et al., 2020). Accurate self-care assessment tools enable healthcare providers to gauge an individual’s capacity for self-care. This allows for the provision of tailored support at the most appropriate time, across different healthcare and community settings (Coulter et al., 2015). The advancement of self-care measurement tool development should be synchronized with broader efforts to restructure and finance long-term services and support systems. This coordinated approach is vital to ensure comprehensive care for older adults (Fulmer et al., 2021).
While various tools exist to measure self-care and self-management of chronic conditions in the general adult population (e.g., Jaarsma et al., 2003; Riegel et al., 2009; Toobert et al., 2000), a significant gap exists in evidence concerning the characteristics and validity of tools specifically designed for older adults with chronic conditions and multimorbidity. It remains unclear if existing instruments, even those validated in older adult populations, possess structural and conceptual similarities or differences. The sheer number of disease-specific (designed for a particular condition) and non-disease-specific (applicable across diagnoses) instruments can further complicate the selection of an appropriate self-care measurement tool. Furthermore, these tools exhibit variations in their intended purpose, structure, theoretical underpinnings, development methodologies, and the settings in which they have been utilized.
Addressing the Gap in Measurement Tools for Older Adults
Previous reviews have explored both disease-specific and non-disease-specific instruments designed to measure self-care or self-management (Ausili et al., 2014; Cameron et al., 2009; Caro-Bautista et al., 2013; Han et al., 2014; Hudon et al., 2021; Lu et al., 2015; Matarese et al., 2017; Packer et al., 2018; Sidani, 2011). These reviews have offered valuable insights into instruments for adult populations (18 years and older). However, they have not specifically focused on the unique needs of older adults living with chronic conditions or multimorbidity. This demographic often experiences increased healthcare utilization, a higher burden of treatment, and geriatric syndromes like frailty. Notably, there has been a lack of prior reviews specifically examining instruments that measure self-care and self-management in older adults facing chronic conditions. Therefore, a critical need exists to identify and evaluate the range of self-care measurement tools available and appropriate for community-dwelling older adults (60 years and older). This targeted evaluation is the crucial next step in ensuring effective and tailored healthcare for this growing population.
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