Week 4 Becoming an active self-manager

What is active self-management?

The individual’s ability to manage the symptoms, treatment, physical, and psychosocial consequences, and lifestyle changes inherent in living with a chronic condition

Self-management is a daily ____________ process

Decision-making

Active self-managers maintain participation in life despite _______

Illness

Passive self-managers withdraw and ….

Allow illness to dominate

Self-management is always a ________

Choice

Occupational therapist implementing coaching strategies to help clients be…

Active self-managers

What are the core self-management tasks?

Medical- caring for health conditions

Role- maintaining or adapting roles

Emotional- managing emotions

What are the essential tools of self-management?

Problem solving

Decision making

Action planning

What percentage of individuals adhere to their prescribed chronic illness regimens?

~50

What are adherence barriers?

Complexity of regimens

Treatment burden

Disrupted routines

What are the different types of non-adherence?

Intentional

Unintentional

What is intentional non-adherence?

When a client consciously chooses not to follow their treatment plan

What is unintentional non-adherence?

When a client wants to adhere to their treatment but fails due to forgetfulness, misunderstanding instructions, or environmental barriers

What is the role of prospective memory in adherence?

It is the ability for an individual to remember to perform a task in the future; failures of this memory leads to individuals forgetting to do some thing in their treatment plan

How is social support a facilitator of treatment adherence?

Clients with strong social support systems are often better equipped to handle to challenges of chronic disease

What do psychological factors directly affect when it comes to self-management of a chronic condition?

Adherence, QOL, and outcomes

Health ______ and ______ affect motivation

Beliefs, perceptions

Coping strategies influence…

Long-term outcomes

What are the emotional factors that affect self-management of a chronic condition?

Stress, anxiety, and depression

What are the social factors that affect self-management of a chronic condition?

Lack of social support; social isolation and increased non-adherence

What are the cognitive factors that affect self-management of a chronic condition?

Health beliefs and illness perceptions influence how patients approach treatment

What are effective empowerment strategies that you can use to promote self-management in a patient?

Self-management education

Shared decision making and collaborative goal setting

Peer support and self-confidence building

Health literacy an educational resources

What is the role of an OT when using empowerment strategies?

Ensure autonomy and self-efficacy of the patient

Motivation in chronic illness cannot be understood as a single force, but as a…

Dynamic interaction of internal and external factors

What is does allosteric learning model propose?

Behavior change occurs through a process of simultaneous deconstruction and reconstruction of beliefs and habits

What must clients do under the allosteric model?

Gradually replace old, unhelpful routines with new ones that better support health

What is a challenge of the allosteric model is trying to address?

It is not easy to erase old habits, that is why the model proposes a layering a new meanings and behavior over time to promote lasting change

What is the “didactic therapeutic environment”?

An approach that fosters intrinsic motivation by respecting patients’ prior beliefs and lived experiences

Motivation in chronic illness is not a simple trait or fixed personality factor. Instead it emerges from the interaction of what two elements?

Internal needs

Environment

Internal needs include Maslow type drivers such as…

Safety

Belonging

Self-esteem

Self-actualization

Environment includes the therapeutic…

Context, support systems, and cues that shape behavior

Even if someone has a strong internal drive, without an enabling __________ motivation cannot translate into ___________ change

Environment, behavior

Internal readiness must be present in a supporting environment for…

Change to occur

When it comes to change, OTs must focus on ___________ and ____________, not just behavior alone

Readiness, self-efficacy

What are strategies an OT can use if readiness is high but confidence is low?

Ones that build skills and supports

What are strategies and OT can use if readiness is low?

More focus on exploring ambivalence and connecting change to meaningful values

What significantly improve patient engagement, but only when they are designed with motivational strategies in mind?

Remote measurement technologies

What are the limitations of remote measurement technologies?

Declining motivation over time

Difficulty sustaining engagement without human support

The need for personalization not being met

What are motivational strategies a remote measure technology can use to support self-management and motivation?

Feedback

Health literacy

Reminders

Goal-setting

Social interaction

Gamification

Rewards

Self-management is more than compliance, its is a …

Dynamic process of maintaining health in the setting of chronic illness

What is OT’s role in self-management?

Supporting medical management

Addressing role management

Facilitating emotional management

Advocacy and environmental supports

What are applications in OT practice that are used to promote self-management?

Readiness rulers- motivation and confidence levels

QOL assessments- identify domains needing support

Action planning

Reflection and feedback on OT sessions

Active self-management improves…

QOL

What are key to success in self-management?

Motivation, empowerment, and psychosocial care

what do OTs facilitate in self-management?

Adherence, coping, and resilience