Beliefs about personal control and self-management in 30–40 year olds living with Inflammatory Bowel Disease: A qualitative study
Introduction
The impact of chronic illness on the individual and society is the subject of increasing attention within international health policy and health service recommendations (AIHW, 2008, Department of Health, 2005, WHO, 2005). In the United Kingdom it is estimated that approximately 17.5 million adults suffer from at least one long term condition, a figure which is expected to rise by 23% by 2026 (DH, 2001). Clinical research and health policy support the benefits of promoting choice and maximum individual control, including the use of effective self-management strategies (Department of Health, 2005, HM Government, 2007, Lorig and Holman, 2003).
Section snippets
Inflammatory Bowel Disease
IBD is a collective term for two life-long inflammatory disorders of the gastrointestinal tract: Ulcerative Colitis (UC) and Crohn's Disease (CD). Similar to other long term conditions, sufferers commonly experience periods of exacerbation and remission. These are characterised by symptoms such as rectal bleeding, urgency, diarrhoea, loss of appetite, abdominal pain, fatigue and for some, extra-intestinal manifestations including those affecting the skin, joints and eyes (Vermeire and
Understanding personal control beliefs
Decades of research in sociology and psychology have identified that a sense of personal control is important to psychological functioning and a robust predictor of physical and mental well-being (Skinner, 1996). The design of this study was informed by two common constructs of personal control: multi-dimensional health locus of control (MHLoC) (Wallston et al., 1978); and self-efficacy (Bandura, 1977).
Aim
The overall aim was to explore participants’ beliefs about their role and the role of others in controlling and managing their condition. Participants were encouraged to discuss their strategies of self-management, or what ‘things they did’ as part of managing their condition. The study sought to explore participants’ perspectives of themselves before and since diagnosis, the impact that having the condition had on relationships with others and their views about quality of life.
Design
This phase of
Results
One main theme was identified from the interview data: ‘Reconciliation of the self in IBD’. This was based on three sub-themes and eight basic themes (Fig. 2).
Discussion
This study provides new knowledge about how people aged 30–40 years view the control and self-management of IBD. Two well recognised theories of personal control, MHLoC (Wallston et al., 1978) and self-efficacy (Bandura, 1977, Bandura, 1995) provided effective sensitising constructs for this exploratory qualitative study. Two sources of self-efficacy (performance accomplishments and physiological feedback) (Bandura, 1995), and references to luck, chance and trust in health care professionals
Strengths and limitations of the study
To the authors’ knowledge, this represented the first qualitative exploration of personal control beliefs in IBD and their relationship to self-management strategies.
While existing measures of personal control may have captured the ‘level’ of personal control reported by participants, data analysis identified the process of reconciling ‘self-discrepancies’ (Higgins, 1987) in personal control beliefs. However, while data saturation was gained within this sample of 24 participants, these
Implications for clinical practice
By identifying aspects of life that have the greatest level of self-discrepancy for patients with IBD, it is recommended that nurses devise plans of support and self-management according to individual need and life priorities. In support of existing research (Robinson, 2004, Rogers et al., 2005), services aimed at encouraging directed self-management in IBD require the essential elements of mutual acknowledgement, continuity of care, embracing experiential knowledge and the provision of
Acknowledgments
We are indebted to the individuals who freely gave their time to participate in this research. Sincere thanks also to Dr K. Teahon, Dr A. Jawhari, Dr R. Long and IBD clinical nurse specialists who provided support in recruiting participants to this study.
Conflict of interest
None declared.
Funding
This work was funded by Economic and Social Research Council (+3 PhD Studentship), by School of Nursing, University of Nottingham, and by Institute of Clinical Research, University of Nottingham.
Ethical
References (57)
- et al.
Reconsidering patient empowerment in chronic illness: a critique of models of self-efficacy and bodily control
Social Science & Medicine
(2008) Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences
Gastroenterology
(2004)- et al.
Patient empowerment and control: a psychological discourse in the service of medicine
Social Science & Medicine
(2003) Provider-based complementary and alternative medicine use among three chronic illness groups: associations with psychosocial factors and concurrent use of conventional health-care services
Complementary Therapies in Medicine
(2008)- et al.
Coping style, locus of control, psychological distress and pain-related behaviours in cancer and other diseases
Psychology, Health and Medicine
(2002) - et al.
Sense of control and adjustment to breast cancer: the importance of balancing control coping styles
Behavioral Medicine
(1999) Australia's Health 2008
(2008)Self-efficacy: toward a unifying theory of behavioral change
Psychological Review
(1977)Self-Efficacy in Changing Societies
(1995)Working for a Healthier Tomorrow
(2008)