Self-Management: Theory, Research, and OT applications

Self-management

the ongoing, collaborative process by which individuals develop skills, confidence, and routines to manage health conditions within the context of daily life and meaningful occupations

Self-management was expanded by OT to focus on ______-_____ ______ and embed strategies into a person’s everyday occupations, environments, and roles

occupation-centered approaches

What are three important theoretical frameworks involved in self-management?

1. Integrated Theory of Health Behavior Change (ITHBC)

2. Individual and Family Self-Management Theory (IFSMT)

3. Transtheoretical Model of Behavior Change

Purpose of ITHBC

Explains how health behavior change happens and how to promote it

Level of focus of ITHBC

Focuses on personal behavior change mechanisms

Core elements of ITHBC

Knowledge & Beliefs, self-regulation, social facilitation, behavior, outcomes

Strengths of ITHBC

Strong, integrated behavior change model for health promotion

OT use of ITHBC

Designing interventions to create behavior change

What are the components of belief in ITHBC?

• Self-efficacy

• Outcome expectancy

• Goal congruence

What are the components of social facilitation in ITHBC?

• Influence

• Support (emotional, instrumental, informational)

• Collaborative negotiation

IFSMT helps us understand what makes self-management easier or harder and what leads to better ______ ______

health outcomes

Purpose of IFSMT

Explains how individuals/families manage chronic conditions within context

Level of focus of IFSMT

Includes family, social environment, and long-term outcomes

Core elements of IFSMT

Context, process, and outcomes

Strengths of IFSMT

Emphasizes family and environment; fits OT’s occupation of focus

OT use of IFSMT

Understanding client/family context for SM

Proximal outcomes

Individual and Family self-management behaviors

Distal outcomes

Health status

What are the stages of the TTM?

1. Pre-contemplation

2. Contemplation

3. Preparation

4. Action

5. Maintenance

Pre-ceontemplation stage

No recognition of need for, or interest in, change

Contemplation stage

Thinking about changing

Preparation

Planning for change

Action

Adopting new habits

Maintenance

Ongoing practice of new, healthier behavior

OT strategy in pre-contemplation stage

Education on risks vs benefits and positive outcomes related to change

OT strategy in contemplation stage

Identify barriers and misconceptions; address concerns; identify support system

OT strategy in preparation stage

Develop realistic goals and timeline for change; provide positive reinforcement

OT strategy in action stage

Provide positive reinforcement

OT strategy in maintenance and relapse prevention

Provide encouragement and support

Self-efficacy

Believing you can do something in a specific situation

When people feel confident, they are more likely to stick with _____ ______

health routines

Ways to determine efficacy judgements

• Vicarious experiences

• Physiological feedback

• Verbal perusasion

• Performance outcomes

Steps in problem-solving worksheets

1. Define the problem clearly

2. List possible solutions

3. Consider pros and cons

4. Choose the best solution

5. Make a plan

6. Review the results