Patient participation, adherence, and activation for self-management among adult patients with multimorbidity in primary healthcare settings

Patients with multimorbidity - defined as the co-existence of two or more chronic conditions in an individual - are a growing, heterogeneous group of patients characterised by a dispersal of care across multiple caregivers and settings. This often leads to fragmentation of care. The key to care is the patient's ability to self-management, which requires reconciling the demands of multiple conditions in their daily lives.

Multimorbidity is a global public health challenge and a priority for health research. However, little research is yet available on quality care. The ongoing health and social services reform makes this issue even more topical, as welfare regions need to develop their health services. Taking the patient's perspective into account is crucial to the development of services.

The purpose of this study was to describe and explain patient participation, adherence, and activation - that is knowledge, skills and confidence - for self-management among primary healthcare patients with multimorbidity, and the associations between these and patient-related factors, and subsequently to produce a model to describe this phenomenon. Patient participation, adherence, and activation for self-management were assessed using questionnaire data collected from patients.

The result showed that patients perceived patient participation as important, but their accounts of the extent to which this had been realised in healthcare encounters varied. Most patients had good adherence to care regimens, but adherence to healthy lifestyle behaviours was more frequently inadequate. Significant explanatory factors for adherence were energy and will-power, motivation, results of care, sense of normality, fear of complications and additional diseases, and support from nurses, physicians, and family and friends. Almost half of the patients had low patient activation; they had significantly poorer adherence to several self-management elements and poorer perceptions of their self-management, patient participation and health-related quality of life. There were statistically significant positive associations between patient participation, adherence, and activation, and they and their specific elements were associated with various patient-related factors. Perceived health and loneliness were found to play an important role.

The results showed that self-management in the context of multimorbidity is a complex and evolving process where patient participation, adherence and activation are pivotal factors. The results highlight the importance of the patient's own role, as well as the collaboration between the patient and healthcare professionals and a holistic approach to care