Barriers to, and Facilitators of, Patient Self-Management of Chronic Conditions: An Integrative Literature Review

The prevalence of adults with chronic medical conditions in the United States is growing. Adequate self-management of chronic conditions enables patients to manage unpleasant symptoms, improve quality of life, avoid life-threatening situations, and slow disease progression. Patients require support from healthcare providers to learn to optimally manage their chronic condition(s). The increasing volume of patients requiring assistance necessitates redesigned approaches to self-management support to meet the demand. The purpose of this inquiry is to gain a deeper understanding of the barriers to, and facilitators of, self-management in adults and to provide recommendations for nursing interventions and healthcare provider approaches that support efforts to self-manage chronic conditions. An integrated review method was used to explore research published between 2006 and 2020, identified from CINAHL, PsycINFO, MEDLINE®, and PubMed databases. The theoretical framework organizing the literature review findings is the Theory of Self-Care of Chronic Illness. In addition, Wagner’s Chronic Care Model is a quality improvement model that addresses the complexity of integrating self-management support into healthcare delivery infrastructure and is used to form action steps. The 22 chosen articles revealed numerous factors influencing self-management. These are categorized into three domains: patient-specific factors, healthcare provider-specific factors, and health system/organization factors. The factors are complex, multifaceted, and interconnected, and it is the unique combination that influences the individual’s ability to self-manage. Awareness of these factors can help HCPs and organizations develop patient-specific interventions to mediate barriers to self-management. The findings were used to create practical recommendations to overcome barriers to self-management