Adherence to self-management in patients with multimorbidity and associated factors: A cross-sectional study in primary health care.

AIM The aim of the study was to explore the adherence to self-management of patients with multimorbidity, identify associated factors, and determine explanatory factors of their adherence to self-management in terms of the Theory of Adherence of People with Chronic Disease. BACKGROUND Adherence to self-management is essential for successful care of multimorbid patients, but multimorbidity poses challenges for both patients and practitioners due to its care complexity and broad impact on patients' lives. DESIGN A cross-sectional, descriptive exploratory design with the STROBE reporting checklist was applied. METHODS Adult multimorbid patients who attended primary healthcare consultations in Finland were surveyed using self-administered questionnaires with several instruments including the Adherence of People with Chronic Disease Instrument, Kasari's FIT Index, and Alcohol Use Disorders Identification test. Responses of 124 patients were analysed using descriptive statistics, Spearman correlations, binary logistic regression analysis, and Chi-squared, or corresponding, tests. RESULTS Most patients' responses indicated good or adequate adherence to care regimens and medications. However, adherence to self-management for a healthy lifestyle was more frequently inadequate. Adherence was significantly associated with several patient-related factors, including demographic and health-related factors, perceived adequacy of loved ones, and patient activation. Significant explanatory factors for adherence included energy and willpower, motivation, results of care, sense of normality, fear of complications and additional diseases, and support from nurses, from physicians, and from family and friends. Various factors were relevant for specific aspects of self-management. CONCLUSIONS Multimorbid patients' adherence to self-management is not an 'all or none phenomenon, but a multifaceted process with numerous associated and explanatory factors. RELEVANCE TO CLINICAL PRACTICE The findings highlight needs for an individualised whole-person approach in multimorbid patients' care to provide the required support for good adherence to self-management. Healthcare professionals, especially nurses working in primary health care, are well-positioned to meet this need.

[1]  S. Elo,et al.  The effects of health coaching on frequent attenders' adherence to health regimens and lifestyle factors: a quasi-experimental study. , 2020, Scandinavian journal of caring sciences.

[2]  K. Khunti,et al.  Healthy lifestyle and life expectancy in people with multimorbidity in the UK Biobank: A longitudinal cohort study , 2020, PLoS medicine.

[3]  R. Balicer,et al.  Assessing guideline-concordant care for patients with multimorbidity treated in a care management setting. , 2020, Family practice.

[4]  Paolo Vineis,et al.  Lifestyle factors and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study , 2020, BMC Medicine.

[5]  T. Saaranen,et al.  Support from next of kin and nurses are significant predictors of long-term adherence to treatment in post-PCI patients , 2019, European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology.

[6]  K. Khunti,et al.  Physical activity, multimorbidity, and life expectancy: a UK Biobank longitudinal study , 2019, BMC Medicine.

[7]  C. Hudon,et al.  Characteristics of self-management among patients with complex health needs: a thematic analysis review , 2019, BMJ Open.

[8]  S. Hogg-Johnson,et al.  Increasing Trajectories of Multimorbidity Over Time: Birth Cohort Differences and the Role of Changes in Obesity and Income , 2018, The journals of gerontology. Series B, Psychological sciences and social sciences.

[9]  A. Marques,et al.  Physical activity buffers the negative relationship between multimorbidity, self-rated health and life satisfaction , 2018, Journal of public health.

[10]  H. Kautiainen,et al.  Decreasing muscle performance associated with increasing disease activity in patients with rheumatoid arthritis , 2018, PloS one.

[11]  M. Kääriäinen,et al.  A study of the relationship between the quality of lifestyle counselling and later adherence to the lifestyle changes based on patients with stroke and TIA , 2018, Clinical rehabilitation.

[12]  C. Jagger,et al.  Projections of multi-morbidity in the older population in England to 2035: estimates from the Population Ageing and Care Simulation (PACSim) model , 2018, Age and ageing.

[13]  T. Saaranen,et al.  Predictors of adherence to treatment by patients with coronary heart disease after percutaneous coronary intervention , 2018, Journal of clinical nursing.

[14]  T. Fahey,et al.  Measuring medication adherence in older community-dwelling patients with multimorbidity , 2017, European Journal of Clinical Pharmacology.

[15]  L. Fratiglioni,et al.  The Effect of a 2-Year Intervention Consisting of Diet, Physical Exercise, Cognitive Training, and Monitoring of Vascular Risk on Chronic Morbidity-the FINGER Randomized Controlled Trial. , 2017, Journal of the American Medical Directors Association.

[16]  K. Polkinghorne,et al.  Factors associated with patient activation in an Australian population with comorbid diabetes and chronic kidney disease: a cross-sectional study , 2017, BMJ Open.

[17]  J. Hibbard,et al.  Does patient activation level affect the cancer patient journey? , 2017, Patient education and counseling.

[18]  K. Khunti,et al.  Association Between Lifestyle Factors and the Incidence of Multimorbidity in an Older English Population , 2016, The journals of gerontology. Series A, Biological sciences and medical sciences.

[19]  C. Millett,et al.  Associations between multimorbidity, healthcare utilisation and health status: evidence from 16 European countries. , 2016, Age and ageing.

[20]  I. Boutron,et al.  Potential workload in applying clinical practice guidelines for patients with chronic conditions and multimorbidity: a systematic analysis , 2016, BMJ Open.

[21]  J. Ayuso-Mateos,et al.  Global Multimorbidity Patterns: A Cross-Sectional, Population-Based, Multi-Country Study. , 2016, The journals of gerontology. Series A, Biological sciences and medical sciences.

[22]  J. Korpelainen,et al.  Adherence to health regimens among frequent attenders of Finnish healthcare , 2016, International journal of circumpolar health.

[23]  T. Saaranen,et al.  Motivation is a crucial factor for adherence to a healthy lifestyle among people with coronary heart disease after percutaneous coronary intervention. , 2015, Journal of advanced nursing.

[24]  Sherry L Pagoto,et al.  The association between patient activation and medication adherence, hospitalization, and emergency room utilization in patients with chronic illnesses: a systematic review. , 2015, Patient education and counseling.

[25]  C. Gardner.  Adherence: a concept analysis. , 2015, International journal of nursing knowledge.

[26]  T. Fahey,et al.  Managing patients with multimorbidity in primary care , 2015, BMJ : British Medical Journal.

[27]  Susana B. Martins,et al.  Quality of Care for Patients with Multiple Chronic Conditions: The Role of Comorbidity Interrelatedness , 2014, Journal of General Internal Medicine.

[28]  M. Gulliford,et al.  Impact of body mass index on prevalence of multimorbidity in primary care: cohort study , 2013, Family practice.

[29]  Wendy Macdonald,et al.  Multimorbidity, service organization and clinical decision making in primary care: a qualitative study. , 2011, Family practice.

[30]  M. Kääriäinen,et al.  Adherence of Finnish people with glaucoma to treatment plans and connected factors , 2011, International journal of circumpolar health.

[31]  D. Kivlahan,et al.  Brief Approaches to Alcohol Screening: Practical Alternatives for Primary Care , 2009, Journal of General Internal Medicine.

[32]  Matthias Egger,et al.  The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies , 2007, PLoS medicine.

[33]  H. Bosworth,et al.  Supporting self-management for patients with complex medical needs: recommendations of a working group , 2007, Chronic illness.

[34]  Judith H Hibbard,et al.  Development and testing of a short form of the patient activation measure. , 2005, Health services research.

[35]  T. Bodenheimer,et al.  Patient self-management of chronic disease in primary care. , 2002, JAMA.

[36]  M. Kääriäinen,et al.  Adherence with health regimens of patients on warfarin therapy. , 2013, Journal of clinical nursing.

[37]  M. Fathalla,et al.  World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. , 2013, JAMA.

[38]  H. Kyngäs.  A theoretical model of compliance in young diabetics. , 1999 .