Philosophical Underpinnings 

Our focus is theory-driven research. In the Middle Range Theory of Self-Care of Chronic Illness developed by Riegel, Jaarsma, and Strömberg, self-care is defined as a process of maintaining health through health promoting practices and managing illness. Self-care is performed in both healthy and ill states. Everyone engages in some level of self-care daily with tooth brushing, food choices, and so forth. When an ill individual is stable, he or she is often able to maintain health without moving into illness management. But, once illness management becomes a priority, behaviors addressing health maintenance remain. Thus, self-care in healthy and ill states can be, but is not always, a simultaneous process.

Self-care might be more salient to those with a chronic illness. In such situations, self-care often requires a set of behaviors to control the disease, decrease the burden of symptoms, and improve survival. Sometimes self-care involves health promotion behaviors such as a healthy diet, exercise, and social support. In other situations, self-care involves monitoring of signs and symptoms and initiating treatments when changes are recognized.

We define self-care as involving self-care maintenance (e.g. taking medication as prescribed), self-care monitoring (e.g. routinely monitoring symptoms), and self-care management (e.g. adjusting diet or medication based on detection and interpretation of symptoms). We recently updated the theory by integrating symptoms. With this addition, we clarified the important contribution of symptoms to each of these three processes.

The decisions made by people regarding self-care are influenced by a broad array of factors. Effective self-care requires knowledge, skills, confidence and motivation to engage in self-care in spite of everyday barriers. Common barriers to self-care include depression, lack of confidence, trouble thinking, poor sleep, and other illnesses. Informal supporters or caregivers, typically family members, exert a powerful influence on self-care. Lack of support is an important barrier to self-care.

Self-care is relevant for all chronic conditions and throughout the entire trajectory from prevention to palliative care.  We have learned that those who report more effective self-care have better quality of life, are admitted less frequently to a hospital, and live longer than those who report poor self-care. In spite of these studies, further research is needed to fully understand the mechanisms by which self-care exerts benefit. And, research in varied illness populations, especially those with multiple chronic conditions, is essential.