Factors influencing self-management priority setting and decision-making among Chinese patients with acute coronary syndrome and type 2 diabetes mellitus

Abstract

Background: Priority setting and decision-making in relation to self-management of multiple conditions is particularly challenging for both patients and health professionals. The aim of this study was to validate a conceptual model of self-management priority setting and decision-making in multimorbidity and confirm factors that influence self-management prioritizing and decision-making in a sample of patients with acute coronary syndrome and type 2 diabetes mellitus. Methods: This was a qualitative study using deductive directed content analysis. A purposive sample of 21 participants with acute coronary syndrome and type 2 diabetes mellitus that were admitted to a Shanghai hospital were interviewed. Results: Participants provided evidence to confirm all but one of the factors from the conceptual model. Internal factors influencing self-management predominated. Agreement with recommended treatment, functional capacity and perceived synergies, antagonistic effects, or interactions among the conditions and prescribed treatments, was emphasized. The facilitators and barriers to priority setting and decision-making were related to available resources, provider communication and, to a lesser extent, confusion about recommendations, and treatment complexity. Some participants were also concerned about treatment side effects. Conclusions: Internal factors (personal beliefs, preferences, and attitudes) and facilitators and barriers (knowledge, finances, social support, and transportation) were related to changes in priority setting and decision-making and self-management behavior in this sample. Health education, which includes case studies with shifting self-management priorities is recommended, rather than a unique disease-specific focus. Further research, exploring the relationship between these factors and changes in the dominant condition and related management, using valid and reliable instruments that capture these key factors, is recommended.

The experience of financial burden for people with multimorbidity: A systematic review of qualitative research

“…Seven of these studies 35‐41 aimed to research financial burden or a related concept. The remaining 39 studies 34,42‐79 researched several issues including self‐management, 42,44‐46,48,55,57,60 adherence 43,52,56,62,64 and living with multimorbidity 63,66,67,70,75 . There were 4,364 unique participants in total.…”

“…Two studies, 73,74 used online questionnaires and included 2,689 participants, while the remaining 44 studies included 1,675 participants. From the forty‐one studies 36‐47,49‐68,70‐79 reporting participants’ gender, 1,386 (63.3%) were male, 799 (36.5%) were female, one (0.0004%) was a transgender female and two (0.001%) were described as ‘other’. The mean age for participants was 53.6 years (from 28 studies 36,37,39,40,43‐45,47‐50,52,53,56,59‐61,63,65‐68,71,74‐78 ).…”

“…The mean number of conditions for participants was four (from 20 studies 39,41,43,45‐48,50,51,54,59,61‐63,65,66,71,76,78,79 ). The number of participants with multimorbidity was 2,631 (from 38 studies 34,36,38‐40,42‐50,52‐55,57‐63,65‐68,70,71,73‐79 ). As outlined in the methods, some studies contained participants with a single chronic condition, but data on experience of financial burden were only extracted for participants with two or more chronic conditions.…”

“…Twenty‐six studies were conducted in North America, 36,37,40,44‐47,49‐51,53‐56,62,65,67‐69,71,72,75‐79 one in South America, 41 four in Africa, 42,59,60,63 four in Asia, 43,57,61,64 three in Europe, 48,66,74 seven in Oceania 34,35,38,39,52,58,70 and one study was conducted in multiple continents 73 . Twenty‐five of the 46 included studies did not state a specific methodological approach, 35,37‐39,43,44,46,47,49‐51,54‐58,61,63,72‐74,76,78,79 six used a form of phenomenology, 41,59,60,62,65,70 three used grounded theory, 36,40,64 three used interpretive approaches, 34,67,75 three used ethnography, 45,66,68 one used narrative inquiry, 52 one used narrative case study 53 and one used a descriptive approach 77 . Three studies used mixed methods, 42,69,71 all of which included primary qualitative data collection.…”

<p>Chinese Hospitalized Cardiovascular Patients’ Attitudes Towards Self-Management: A Qualitative Study</p>

“…Fitzpatrick et al 17 used photovoice to photograph Asian elders' perceptions of scenes promoting or acting as barriers to cardiovascular health. Liu et al 18 found that different attitudes influenced self-management priority setting and decision-making among Chinese patients with acute coronary syndrome and type 2 diabetes mellitus through deductive directed content analysis. As such, adopting patients' attitudes can lead to a better understanding of how an individual's real demands on treatments to achieve the setting-goals, help to tailor individualized self-management strategies and reduce the financial burdens at all levels.…”