Self-management challenges following hospital discharge for patients with multimorbidity: a longitudinal qualitative study of a motivational interviewing intervention

Abstract

ObjectivesThe aim of this study was to describe challenges in self-management activities among people with multimorbidity during a 4-week post-discharge period.DesignThis is a longitudinal qualitative study using data from a randomised controlled trial (RCT) of motivational interviewing (MI) sessions.SettingThe RCT was conducted at six wards in two hospitals—one university hospital and one general hospital in Stockholm, Sweden, during 2016–2018.ParticipantsSixteen participants from the intervention group, diagnosed with heart failure or chronic obstructive pulmonary disease and at least one other chronic condition, were purposively selected for this study.InterventionsEach participant had four or five post-discharge MI sessions with a trained social worker during a period of approximately 4 weeks. The sessions were recorded digitally and analysed using content analysis. Altogether, 70 recorded sessions were analysed.ResultsSelf-management after hospital discharge was a dynamic process with several shifting features that evolved gradually over time. Patients with multimorbidity experienced two major challenges with self-management in the first 4 weeks following hospital discharge: ‘Managing a system-centred care’ and ‘Handling the burden of living with multiple illnesses at home post-discharge’.ConclusionsSelf-management for patients with multimorbidity in the first post-discharge period does not equate to a fixed set of tasks, but varies over the post-discharge period. Self-management challenges include not only the burden of the disease itself, but also that of navigating and understanding the healthcare system. Hence, self-management support post-discharge involves both aiding patients with care coordination and meeting their gradually shifting disease-related needs.Trial registration numberNCT02823795.

Use of Motivational Interviewing in Older Patients with Multiple Chronic Conditions and Their Informal Caregivers: A Scoping Review

“…For the mixed-method study [ 53 ], the qualitative and quantitative components of the study were analyzed separately. In the three qualitative articles and in the qualitative component of the mixed method article, cross-sectional designs [ 49 , 50 , 53 ], and a longitudinal design [ 54 ] were used. Regarding the articles reporting quantitative studies, four used a quasi-experimental design [ 53 , 55 , 56 , 57 ], and eight a RCT design [ 47 , 48 , 51 , 52 , 58 , 59 , 60 , 61 ] ( Table 1 ).…”

“…Regarding the articles reporting quantitative studies, four used a quasi-experimental design [ 53 , 55 , 56 , 57 ], and eight a RCT design [ 47 , 48 , 51 , 52 , 58 , 59 , 60 , 61 ] ( Table 1 ). The qualitative data were collected by using individual interviews [ 49 , 50 , 54 ] and focus groups [ 60 ], and analyzed through thematic [ 60 ], content [ 54 ] and theoretical framework [ 49 , 50 ] analyses. The studies were conducted in Australia [ 49 , 50 , 51 , 52 , 60 ], the USA [ 53 , 56 , 59 ], Spain [ 47 , 48 , 55 ], Brazil [ 58 ], Italy [ 61 ], Turkey [ 57 ] and Sweden [ 54 ] ( Table 2 ).…”

“…Type of intervention. The MI was used as a stand-alone intervention in five articles [ 47 , 48 , 54 , 58 , 59 ], and in the remaining as a component of multifactorial interventions (i.e., medication self-management intervention [ 52 ]), programs (i.e., patient-centered prescription model [ 55 ], medication self-management support program [ 56 ], chronic disease self-management program [ 53 ], care management program [ 61 ], or services (i.e., community pharmaceutical care services [ 57 ]. A few studies reported the conceptual framework that the intervention or program was based on, such as the Health Belief Model [ 51 , 52 ], the Behavioral Change Wheel [ 57 ], and Cognitive Behavioral Therapy [ 53 ].…”

Medication communication with older adults experiencing chronic illness and polypharmacy

“…Patients might also need individual self-management support during the first period at home. Self-management is gradually changing as the time goes from hospital discharge (Brandberg et al, 2021). Therefore, repeated contact with healthcare professionals might be implicated after discharge.…”

“…In Study II, a previous unplanned admission as a predictor of time to readmission may indicate that these patients were fragile and required recurrent acute hospital care. This highlights that patients with chronic illness need not only a discharge letter, but also individual self-management support during care transitions and the first period at home (Brandberg et al, 2021;Ljungholm et al, 2022).…”