Chances are you are already somewhat familiar with the term “disease self-management.” Its use is widespread in the healthcare industry, and frequently used in the context of living with a long-term health problem. Although healthcare professionals play the central role in diagnosis and recommending treatment, the responsibility for day-to-day management of the problem lies very much with the patient.
Understanding disease self-management, however, can be a complex area to navigate—both from a theoretical perspective and from an applied perspective. This complexity is evident in the vast research literature devoted to the topic that includes multiple definitions, conceptualizations, and applications. In the literature, the term self-management can be used to refer to:
- The behaviors and processes associated with disease self-management;
- The components or features of intervention programs to support self-management; and
- The health-related outcomes of self-management.
So What is Self-management?
At a broad level, disease self-management can be defined as the day-to-day management of a long-term health problem by an individual over the course of their illness. To this end, self-management includes taking prescribed medication and is, therefore, a topic of interest to pharma marketers.
The four self-management principles presented below can help marketers develop programs to effectively support optimal self-management in patients prescribed their products.
1. Disease self-management involves a range of behavioral tasks that are interrelated.
The self-management literature has identified three broad sets of behavioral tasks associated with the work of living with a long-term health problem. These tasks include the medical or behavioral management of a condition, role management to continue with the activities of daily life, and emotional management to cope with the emotional challenges that come with living with a condition. Of these tasks, medical management is the most obviously relevant to pharma, and can include the behaviors of taking prescribed medication, attending doctors’ appointments, adopting dietary changes, and increasing physical activity.
It is important to acknowledge that a comprehensive understanding of self-management needs to go beyond medical management, as the tasks of medical management are so often interrelated and influenced by the tasks of role and emotional management. Take, for example, the patient who is nonadherent to their medication (i.e., a medical management task) because of their difficulty in coping with their underlying feelings of anxiety about their health (i.e., an emotional management task). Or, take the patient who misses their doctor’s appointment (i.e., a medical management task) because they are unable to find the time (i.e., a role management task) to attend the appointment.
Thus, when supporting a patient with their medical management, whether taking medication or attending a healthcare appointment, any program should consider the additional tasks of role and emotional management that might also be significant for an individual patient. Indeed, to truly appreciate the extent of the demands that living with a long-term health problem places on an individual, self-management tasks cannot be viewed in isolation.
2. Self-management is focused on building self-efficacy by building self-management skills.
The very notion of self-management assumes that the patient is an active participant in their healthcare. The concept of self-efficacy is key to understanding the challenges of self-management. Self-efficacy refers to an individual’s belief in their ability to perform a specific task or behavior. Self-management theory suggests that patients with higher levels of self-efficacy are more likely to engage in the necessary tasks of self-management.
Furthermore, the theory states that self-efficacy can be enhanced by supporting patients in acquiring the skills necessary to enable them to better carry out their self-management tasks. The literature identifies a number of core skills necessary to effectively self-manage a long-term health problem, including problem solving, decision-making, resource utilization, formation of a patient-provider partnership and action planning.
3. The most effective self-management support is tailored to patient need.
While the range of self-management tasks and skills are assumed to be shared across all patients living with a long-term health problem, it does not mean that self-management support should be generic or adopt a one-size-fits-all approach. Consideration of the patient population as a segment is important, but even more important, is an understanding of the patients’ own unique beliefs and experiences in living with the condition. The most effective self-management programs support patients to identify and specify the self-management tasks necessary for them, and to acquire the self-management skills as tailored to their own situation. More than that, for any individual, the range of tasks and skills will vary in importance over time. This means that effective self-management support should be dynamic and responsive to the patient’s changing needs.
4. Self-management is about partnership.
In some ways, the term self-management is a little bit of a misnomer. That is because the term suggests it is something that a person does alone. But self-management doesn’t mean going it alone, and the “self” in self-management shouldn’t be seen to exclude or devalue the input and support from other people. For example, partnership with one’s medical team for information, advice, and support is crucial in the effective self-management of a long-term condition. So too, is partnership with other people within one’s social network, such as family and friends. Indeed, successful programs often draw on both HCP and peer support to help promote effective self-management.
In The End…
Self-management is an important concept for patients living with a long-term health problem. At its core, it acknowledges that patients are active participants in managing their own health. Effective self-management requires that patients build self-efficacy through the acquisition of a generic skill set that can be tailored and applied to specific behavioral tasks within the context of a person’s daily routines. Self-management should not be a lonely pursuit, but rather, it should involve partnership with others, including healthcare providers, family, and friends. Equally, pharma marketers are well positioned to further support patients to become effective self-managers through the provision of personalized patient support programs.