Chronic Disease Self-Management and Health Behavior Change Attitudes in Older Adults: The Feasibility of Mixed-Method Design

Self-management in older adults with chronic disease is a crucial skill that affords individuals with the abilities to provide self-care and engage in higher level management skills. These skills allow an individual to proactively address changes in symptoms and risk factors, and to work collaboratively with health care providers. This dissertation explores the attitudes of older adults towards chronic disease and the adaptations required in chronic disease self-management.;In the first manuscript, an integrative review addressed self-management of older adults through the lens of the Social Cognitive Theory (Bandura, 2004), a framework for individual health behavior change. The results of the integrative review indicated research focusing specifically on those over 65 with chronic disease is lacking and that participants of existing studies were predominately white, well-educated females suggesting that those at higher risk for complications have not been sufficiently evaluated. The analysis of published literature led to questions about the role of social support and moral disengagement in chronic disease self-management.;The integrative review described in the second manuscript was designed to identify social support studies in older adults who used self-management to further understand the state of the science in chronic disease self-management. Whereas most self-management programs utilize a peer-led intervention, the results of the integrative review of social support research indicated that individuals' preferred method of participation, utilization of partner support in self-management, had not been sufficiently explored. The analysis described in this manuscript revealed social support increased adherence in self-management. The culmination of findings from both the first and second manuscripts revealed gaps in literature and directed the next phase of the dissertation process, reported in the third manuscript. This manuscript focused on clarification of older adults' perceptions and attitudes towards chronic disease; barriers to self-management, and the role of social support using a mixed-method pilot study designed to answer several questions: 1) Does the proposed method of recruitment provide adequate participation and retention in the chosen population? 2) Do the instruments used to measure outcomes in the study population demonstrate reliability in measuring the chosen variables (barriers to change, motivators to change and readiness to change, morale disengagement, self-efficacy, depression, health literacy, and social support)? 3) Does the proposed method of data collection and interpretation provide consistent data collection and data triangulation for use in future studies? The results accumulated from a convenience, purposive sample of parishioners from churches in northeast Tennessee, older adults diagnosed with hypertension, chronic obstructive pulmonary disease, and Type 2 diabetes. The enrollment process and protocol sufficiently supported the research process; 29 participants were enrolled and completed the study. The feasibility of the protocol implementation and instrumentation use was determined appropriate for use in the older adult population. The results of the study supported protocol validity and using Cronbach's alpha, the reliability of instruments were confirmed.;The feasibility study explored what method would be preferred to make behavior change, such as group or health coaching activities; the participants revealed an interest in having someone to be accountable to and serve in the role of a coach. Of all methods of behavior change surveyed, individuals identified that next to initiating and continuing the change behavior by themselves or with a partner that health coaching would be the most preferred in behavior change. They feared burdening other family members and children with this role. Peers and friends were least likely to be used as support for behavior change. This is a noteworthy finding as self-management programs often use peer support groups. Both the method of change and the preferred relationships were supported in merging of quantitative and qualitative analysis.;Merging of data suggested trends in data responses indicating that each disease impacts an individual differently and responses to self-rated health, self-efficacy, and daily self-management may be negatively impacted by disease complexity and symptoms. The findings were supported in qualitative analysis of focus group data and reported in manuscript four.;In qualitative descriptive analysis, attitudes towards chronic disease indicated that change was based on impact of the disease process. If less impact was perceived, then fewer proactive measures were taken. If change was perceived as not increasing the management of the disease as seen in this study with the participants with COPD, then little change was attempted. Two overarching themes emerged from the analysis of study variables. Those themes were individualization in treatment and care planning and partnership in the decision making process. The themes of partnership and individualization were particularly prevalent related to healthcare providers and standardized "health coaching" that is offered by insurance companies. The participants desired to be an integral part of the healthcare team and to work with providers in improving health. These explorations of self-management and social support have provided a new understanding of the needs and attitudes of the older adult that will be beneficial in future interventional studies.