The paper that drew my attention in this issue is one by Tang et al. (2008), pp. 74–83 because it raised some issues that I contend are inherently problematic in the promotion of chronic condition as an approach relevant for the majority. While I agree that some of the principles of self-management have merit, I do wonder if we are in the midst of another healthcare ‘fad’ that has become popular quickly, but may lose popularity just as fast. Chronic condition self-management is being increasingly incorporated into preventative and public health policies. Is this as a means to contain cost? Have we become overly enthusiastic about the benefits of chronic condition self-management? There is evidence that self-management programmes actually have few sustainable benefits.
Lifestyle-associated chronic disease can be precipitated by risk factors such as inappropriate or inadequate diet, tobacco use, alcohol and other drug misuse, physical inactivity, poverty, inadequate living conditions, violence and discrimination. These factors begin to impact on the individual before birth and can continue throughout the course of life. Many of these factors may be beyond the individual’s control or capacity to alter, compounding the complexity associated with self-management of chronic conditions. Tang et al. (2008) remind us that health literacy – which is the individual’s ability to read, understand and act on instructions – equates with a lower understanding of the illness and associated treatments and lifestyle changes. Medical or health advice may not be prioritized because of other compounding life issues. These are additional factors that impact on the individual’s capacity to self-manage.
Chronic conditions are often progressive in nature and, while significant gains have been made in treatments and interventions over the past years, the gains have been in survival, but not necessarily cure. Longer life often means a life lived with a long-term condition. Treatments of chronic diseases are often complex due to the existence of several inter-related conditions. Following diagnosis and being given prescriptive advice, people themselves must learn how to incorporate treatment regimes and the consequences and symptoms of the conditions into their everyday lives. Promotion of self-management of chronic conditions must equate with allowing the individual to engage in a learning process of trial and error. People living with chronic conditions often self-manage with minimal intervention from health professionals. How prepared are health professionals to work alongside an individual who is trying to find ways to adapt their lives to the consequences of illness?
People come to the illness experience with a multitude of skills and past experiences which they draw on to adapt to life with a chronic condition. Many people develop an intuition and experiential knowledge base about what is right for them in their circumstances The process of searching for options, trialling actions and activities and experiencing the consequences equips the person with a depth of knowledge about their responses in certain situations. People make self-management decisions against a background of complex socio-cultural characteristics, psychological interpretations, spiritual beliefs and personal priorities. Consequently, the nature of self-management will be unique to the person and will change over time and circumstance. Just as chronic illness is influenced by the wider context of people’s lives, so too is the willingness and ability to be involved in self-management decisions.
Research into the experience of learning to adapt and integrate chronic conditions into their lives, and how knowledge can be transferred to assist daily decision-making, is profoundly important. I suggest, however, that chronic condition self-management has been around for as long as disease itself. The difference now is that some bureaucrats may be embracing it as a cost effective model considered suitable for the majority. Makes me wonder if we are in the midst of a chronic condition self-management fad that will pass, as did poodle skirts, lava lamps and hot pants.