Disability Expert Carolyn Magura defines chronic disease self-management

Definition of Chronic Disease Self-Management
Based on a comprehensive literature review of over 400 articles, Researchers have proposed the following definition.

Chronic disease self-management involves [the person with the chronic disease] engaging in activities that protect and promote health, monitoring and managing of symptoms and signs of illness, managing the impacts of illness on functioning, emotions and interpersonal relationships and adhering to treatment regimes. There are a number of key elements to this definition that will enable people to develop a practical concept of self-management. It is important to note that these elements are about the behaviors of the patient, rather than models of self-management for health care systems, service providers or health professionals. These elements suggest that self-management:
• Entails engaging in activities that promote health;
• Involves managing a chronic condition by monitoring signs and symptoms;
• Entails dealing with the effect of a chronic condition on personal well being and interpersonal relationships; and
• Involves following a treatment plan prescribed to you by your Doctor(s).

The definition of self-management encompasses a range of behaviors, as well as knowledge and attitudes and is an important starting point towards the development of a concept of chronic disease self-management.

Stages of Behavioral Change
A model of behavior change that has been applied to chronic disease self-management is based on research on how people change behavior, either on their own or within an intervention program (i.e., some sort of action to assist in the change). The theory is that the ceasing of risk behaviors (eg. smoking) and acquisition of health promoting behaviors (eg. physical activity, relaxation) involves the progression through the stages of change. They are:
• Pre-contemplation [not thinking of change]
• Contemplation [thinking of change]
• Determination [ taking preliminary steps to change]
• Action [ actively engaging behavior change]
• Maintenance [ sustained behavioral change]
• Relapse [ can occur at any point.]

Behavioral change is facilitated by a personal sense of control. If people believe that they can take action to solve a problem, they become more inclined to do so and feel more committed to this decision. This "can do" attitude mirrors a sense of control over one's environment. It reflects the belief of being able to master challenging demands by means of adaptive action. It can also be regarded as an optimistic view of one's capacity to deal with stress. (Not to sound redundant, but this really is about the glass being "half-full" and NOT "half-empty".)

Social Learning
OK; with the behavioral change steps understood; now, on to the social learning stage. The theoretical underpinning of effective chronic disease self-management programs should be based on social learning and behavioral theories. The key principles of these theories as applied to chronic disease self-management are:
• Disease management skills are learned and behavior is self-directed; • Motivation and confidence (including self-efficacy) in managing one's condition dictate an individual's success;
• The social environment (ie. family, workplace & health care system) support or impede self-management; and
• Monitoring and responding to changes in disease state, symptoms, emotions and functioning improve adaptation to the chronic condition.

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