Self-management for chronic conditions in low- and middle-income countries: how can we know what works?
Self-management of chronic conditions is an approach to engaging people in their own health care. It places increased responsibility on the patient for monitoring their condition and their adherence to treatment. Wherever health systems are under resource strain, self-management is promoted as a means to increase patient investment in their treatment plan, thus improving treatment adherence and reducing use of costly services. Initiatives to support self-management have included text messaging reminders to monitor blood pressure or blood glucose, and community peer groups to support adherence to medications and lifestyle advice. More recently, the COVID-19 pandemic has further focused attention on self-management of chronic conditions, for example for vulnerable patients who are self-isolating.
Despite increased attention and resources devoted to self-management for chronic conditions, evidence of the effectiveness of self-management limited. This is particularly true in low- and middle-income countries, where self-management is proposed as one response to the challenges that accompany ageing populations, a rapidly increasing prevalence of non-communicable diseases and multi-morbidities, and rising health care costs.
One reason for this lack of evidence is the absence of a common understanding of what self-management means in different contexts, and a standard definition and tool for its measurement. While some work has been done to identify dimensions of self-management of chronic conditions in higher income settings, measures of this concept remain inconsistent. They have also been largely determined without input from all affected stakeholders in the health system. This is despite evidence that self-management is understood differently by health professionals and lay people. To characterise self-management programmes, to evaluate and compare their effectiveness over time and across settings, more work is required to develop tools for measuring self-management that can be adapted to different contexts.
There is also a lack of consensus on the goals of self-management. Most self-management support initiatives focus on an ultimate goal of improved disease outcomes, putting the onus on patients to better manage their own conditions. The impact of these initiatives is not inherently positive. The added responsibility put on patients can represent a burden for many of them, adding to the already significant workload of patient-hood. In many low- and middle-income countries, where health systems are often-fragmented and under-resourced and social support systems are weak, the patient workload may already be particularly heavy. Patients face the work of, for example, financing health care costs from household resources or traveling long distances to seek specialist care. For them, the added responsibility of self-management at home may present a burden rather than an opportunity for improved care.
Rather than a focus on disease control, self-management must instead be about supporting patients to “live well” with their conditions. To do so, any initiatives must not assume that all individuals have access to the same informational, social and psychological resources. Instead, they must be tailored to the varying needs, capacities and expectations of different patients.
Key references
- van Olmen J, Ku GM, Bermejo R, Kegels G, Hermann K, Van Damme W. The growing caseload of chronic life-long conditions calls for a move towards full self-management in low-income countries. Global Health 2011; 7: 38.
- Nolte E, Merkur S, Anell A, editors. Achieving person-centred health systems: evidence, strategies and challenges. Cambridge: Cambridge University Press, 2020.
- Boger E, Ellis J, Latter S, et al. Self-Management and Self-Management Support Outcomes: A Systematic Review and Mixed Research Synthesis of Stakeholder Views. PLoS One 2015; 10(7): e0130990.
- May C, Eton DT, Boehmer KR, et al. Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness. BMC Health Services Research 2014; 14 (1), (281).
Disclamer:
Any views and opinions expressed on this blog are soley those of the original authors and don’t reflect the views and opinions of affiliated organizations, nor those of the Integratedcare4people.org.
Comments are welcome. The blog owner is not responsible for the content in comments and reserves the right to edit or delete any comments submitted to the blog without notice.
Comments
Add your comment
Sign in to add your comment.
prince hanna62 24/10/2020 23:23
I’m so glad i am cured from Herpes..........robinson_bucler @yahoo. com, …………..« ??* ¯……..???? ((Erectile Dysfunction))
cindy ann 09/01/2021 07:06
First, I want to complement this page administrator for creating this platform for us to express our feelings. Herpes is a serious and recurring disease which can't be cured through drugs or injections by the American doctors but the best way to deal with herpes is by taking natural herbs medicine from DR. Tebor the greatest herbalist doctor in the world and is only few American doctors that know about this herbal medicine from Dr Tebor.. I have read about Dr Tebor the great herbalist doctor from African who can cure disease with his powerful herbal medicine. for the people suffering from the following diseases, Herpes,HIV/Aids, Cancer, Also, Hepatitis, Diabetes, Hpv, Infections ETC should contact him for his herbal medicine because i am a living testimony and i was cured of herpes. Although, i sent him what he requested and he sent me his medicine through UPS courier delivery company which i took for 3 weeks and today when i went for test i was tested herpes negative. you can reach him through his email {Teborherbalcenter@gmail.com} or WhatsApp him at +2348106824976 . or website is https:/teborherbalcanter.wordpress.com/
Basson Nalana 11/01/2021 22:24
My hepatitis B positive result turned negative after using Kabuma Herbal Center HBV herbal remedy for SIX WEEKS. I last tested 2019 and was still negative. All thanks to DR Dube. You can contact them through Their website: www.kabumaherbalcenter.com for any chronic illness cure
James Allison 26/01/2021 01:39
Kudos for the content! Apologies for chiming in, I am interested in your opinion. Have you heard about -Research On: Google Or Facebook "Molemen Healing Herbs" (erm, check it on google should be there)? It is an awesome one-off holistic product to get rid of your HSV 1&2 permanently. I've heard some unbelievable testimonies about it and my colleague at work whom I referred to after a lifetime of fighting herpes virus STDs got great healing success with it. Here is their contact information. WhatsApp/ Call: +48732121122 Email: drmolemenspiritualtemple@gmail. com
rose angela 17/02/2021 20:13
Wow this is a welcome development, herbal medicine could be this effective more than those scientific drugs in terms of human health, please save all the stress if it is not worth it. get your herbal product from a genuine herbal practitioner asap, I have used it and it worked so stop giving your hard earned money to Scammers who would want to take advantage of someone who is desperate to be cured i have being a victim of such circumstances, so i know who is real and who isn't i recommend dr festus today for genuine and permanent herbal products Pls help share this post to create awareness of the herbal supplements which can cure anxiety and depression. HIV/AIDS. Diabetes. Epilepsy. Blood Cancer. HPV. ALS. herpes. etc. Visit his website for more reviews https://drfestusfastherbalcure.simdif.com or email drfestusfastherbalcure@gmail.com or send a direct message to WhatsApp contact : +2348112518431
Gina Santos 19/02/2021 14:08
Believe me or not Herbal Medication will remain the only best way to get rid of many disease and virus that said to have no cure, i had herpes virus and my Dad was diagnosed of diabetes for 9 years, I never gave up in doing research on how to get my self cure of genital herpes because it was really terrible for me that i cry when ever i think about my past herpes life, The good news was when i accidentally came across a blog on you tube about Dr Uromi (A NATURAL HERBALIST) on how he has been curing many disease and virus with his herbal remedies that are natural liquid herbs, i immediately copied out his contact mail (Druromiherbalhome@gmail.com ) and ordered his herbs for both me and my dad, to my greatest surprise ever Dr Uromi got me and my Father CURED in the space of 14 Days after using his herbs for three complete weeks and my dad blood sugar was normal 4.0 to 5.4 mmol/L (72 to 99 mg/dL) Once again all thanks to Dr Uromi for curing and restoring health back to my family, Till date Dr Uromi and my dad are best of friends for curing him, to whom it may concern should kindly mail him too on ( Druromiherbalhome@gmail.com ) or WHATSAPP +2349021374574 .
Caroline James 20/02/2021 01:49
I’m very excited to inform everyone that I’m completely cured from HSV1&2 recently. I have used Oregano oil, Coconut oil, Acyclovir, Valacyclovir, Famciclovir, and some other products and it’s really help during my outbreaks but I totally got cured from HSV1&2 with a strong and active herbal medicine ordered from a powerful herbalist called Dr. Nogadu and it completely fought the virus away my nervous system and I tested negative after 14 days of using the herbal medicine. I’m here to let everyone know that the herpes virus has a complete cure, I got rid of mine with the help of Dr. Nogadu and his herbal exploit. Contact him via email: drnogaduherbalist@gmail.com or WhatsApp him at +2349134987375 https://www.facebook.com/Dr-Nogadu-230769121536000/
shonnise Johnson 24/02/2021 21:18
Its a pleasure for me to write this testimony about how i got cured from Genital Herpes 2 months ago. I have been reading so many comments of some people on Youtube who were cured from various diseases by Dr Tebor, but i never believed them. I was hurt and depressed so I was too curious and wanted to try Dr Tebor, then i contacted him through his email (Teborherbalcenter@gmail.com) when i contact him, he assured me 100% that he will heal me and i pleaded with him to help me out. My treatment was a great success, he cure me just as he promised. He sent me the herbal medicine through UPS and instruct me to go for check up after 2 weeks of taking the medication. I agreed with him and took the herbal medicine and i went for check up after two weeks of taking the medication, to my greatest surprise my result was negative. I am really happy that i am cured and healthy again. I have waited for a month to be very sure i was completely healed before writing this testimony. I did another blood test a week ago and it was still Herpes negative. So i guess its time i recommend anyone going through Herpes, HSV-1 or HSV-2, HIV/AIDS, HPV, Hepatitis B, Diabetes and Cancer to contact Dr Tebor on his Email : Teborherbalcenter@gmail.com or Call and Whatsapp him on +2348106824976 His website is https://teborherbalcanter.wordpress.com. He will also cure you just as he did to me and i will continue to share this great testimony on the internet for people to get cured and to know that there is a cure out there and Dr Tebor herbal medicine is the perfect medicine to all manner of diseases.
shonnise Johnson 24/02/2021 21:19
Its a pleasure for me to write this testimony about how i got cured from Genital Herpes 2 months ago. I have been reading so many comments of some people on Youtube who were cured from various diseases by Dr Tebor, but i never believed them. I was hurt and depressed so I was too curious and wanted to try Dr Tebor, then i contacted him through his email (Teborherbalcenter@gmail.com) when i contact him, he assured me 100% that he will heal me and i pleaded with him to help me out. My treatment was a great success, he cure me just as he promised. He sent me the herbal medicine through UPS and instruct me to go for check up after 2 weeks of taking the medication. I agreed with him and took the herbal medicine and i went for check up after two weeks of taking the medication, to my greatest surprise my result was negative. I am really happy that i am cured and healthy again. I have waited for a month to be very sure i was completely healed before writing this testimony. I did another blood test a week ago and it was still Herpes negative. So i guess its time i recommend anyone going through Herpes, HSV-1 or HSV-2, HIV/AIDS, HPV, Hepatitis B, Diabetes and Cancer to contact Dr Tebor on his Email : Teborherbalcenter@gmail.com or Call and Whatsapp him on +2348106824976 His website is https://teborherbalcanter.wordpress.com. He will also cure you just as he did to me and i will continue to share this great testimony on the internet for people to get cured and to know that there is a cure out there and Dr Tebor herbal medicine is the perfect medicine to all manner of diseases. ....
mary vernon 28/02/2021 19:34
I am excited to share this testimony, I was 3 years ago diagnosed with Herpes virus . My medical condition was heartbroken because it was causing me so many our brakes, I was subjected to different medications by my medical doctor just to control the outbreaks. Despite my visit to several doctors my health wasn't getting better, all they could say is for me to stay on the treatment. At the verge of giving up, I went to the internet to search for a treatment on my own at least. But I found a cure instead. On the internet, I read a testimony of a lady who had herpes. She shared an e-mail address of the Doctor. Luckily everything seemed to be okay after I took the Herbal Medicine. I wish I could say that’s the end of it because I haven't had any symptoms since then. Do not expose yourself to more danger, use a herbal remedy that is safe and effective. If interested contact him via email address dr.abaherbalhome@gmail.com or call +2348107155060
mary vernon 01/03/2021 07:47
I am excited to share this testimony, I was 3 years ago diagnosed with Herpes virus . My medical condition was heartbroken because it was causing me so many our brakes, I was subjected to different medications by my medical doctor just to control the outbreaks. Despite my visit to several doctors my health wasn't getting better, all they could say is for me to stay on the treatment. At the verge of giving up, I went to the internet to search for a treatment on my own at least. But I found a cure instead. On the internet, I read a testimony of a lady who had herpes. She shared an e-mail address of the Doctor. Luckily everything seemed to be okay after I took the Herbal Medicine. I wish I could say that’s the end of it because I haven't had any symptoms since then. Do not expose yourself to more danger, use a herbal remedy that is safe and effective. If interested contact him via email address dr.abaherbalhome@gmail.com or call +2348107155060.
shonnise Johnson 01/03/2021 16:29
Tested and trusted finally there is cure for HIV and HERPES and Dr Tebor the great Herbalist has the cure to all manner of diseases, he cured me from HIV and HERPES and my friend from HSV1&2, though I went through different website and i saw different testimonies about different herbalists curing HIV, I was like: “Many people have the cure and why are people still suffering from the virus?” I thought of it, then I contacted Dr. Tebor via email (Teborherbalcenter@gmail.com ), I didn’t believe him that much, I just wanted to give him a try, he replied my mail and Needed some Information about me, then I sent them to him, he prepared the CURE and sent it to me via UPS service. When i receive the herbs, I started taking the medicine as prescribed by him, after 7 days of taking the medicine I went for check-up and the result shows that am HIV and HERPES NEGATIVE. I couldnt believe the result and i went to another hospital for another test and the result still state that am HIV and HERPES negative,that there is no trace of the virus in my system again and the doctors at the hospital celebrate with me and right now i am the most happiest person on earth after suffering from the disease for more than 5yrs. I quickly order for my friend who is suffering from HSV1&2 and he was cured too after using Dr Tebor herbs. Dr TEBOR is gifted and blessed by God and he cure so many disease like HIV, HERPES, CANCER of all kind, DIABETES, HSV1&2, HPV and many more. I’M GOING TO ASSIST ANYBODY THAT WANTS TO CONTACT HIM FOR HELP AND DONT LET ANYBODY DECEIVE YOU IN WHAT YOU BELIEVE THERE IS CURE FOR HIV AND DR Tebor HERBS IS THE PERFECT REMEDY FOR IT!!! You can contact Dr Tebor via email: Teborherbalcenter@gmail.com or you call and whatsapp him on +2348106824976 ..His website is https://teborherbalcanter.wordpress.com
mary vernon 02/03/2021 16:35
I am excited to share this testimony, I was 3 years ago diagnosed with Herpes virus . My medical condition was heartbroken because it was causing me so many our brakes, I was subjected to different medications by my medical doctor just to control the outbreaks. Despite my visit to several doctors my health wasn't getting better, all they could say is for me to stay on the treatment. At the verge of giving up, I went to the internet to search for a treatment on my own at least. But I found a cure instead. On the internet, I read a testimony of a lady who had herpes. She shared an e-mail address of the Doctor. Luckily. everything seemed to be okay after I took the Herbal Medicine. I wish I could say that’s the end of it because I haven't had any symptoms since then. Do not expose yourself to more danger, use a herbal remedy that is safe and effective. If interested contact him via email address dr.abaherbalhome@gmail.com or call +2348107155060
mary vernon 03/03/2021 07:58
I am excited to share this testimony, I was 3 years ago diagnosed with Herpes virus . My medical condition was heartbroken because it was causing me so many our brakes, I was subjected to different medications by my medical doctor just to control the outbreaks. Despite my visit to several doctors my health wasn't getting better, all they could say is for me to stay. on the treatment. At the verge of giving up, I went to the internet to search for a treatment on my own at least. But I found a cure instead. On the internet, I read a testimony of a lady who had herpes. She shared an e-mail address of the Doctor. Luckily everything seemed to be okay after I took the Herbal Medicine. I wish I could say that’s the end of it because I haven't had any symptoms since then. Do not expose yourself to more danger, use a herbal remedy that is safe and effective. If interested contact him via email address dr.abaherbalhome@gmail.com or call +2348107155060
Lucy Morrison 07/03/2021 01:09
I have been suffering from (HERPES SIMPLEX VIRUS) disease for the past four years and had constant pain, especially in my private parts. During the first year, I had faith in God that i would be healed someday. This disease started circulating all over my body and I have been taking treatment from my doctor, few weeks ago I came on search on the internet if I could get any information concerning the prevention of this disease, on my search I saw a testimony of someone who has been cured from (HERPES VIRUS) by this Man Dr ODIDI and she gave the email address of this man and advise we should contact him for any sickness that he would be of help, so I wrote to Dr.ODIDI telling him about my (HERPES VIRUS) he told me not to worry that I was going to be cured!! hmm I never believed it,, well after all the procedures and remedy given to me by this man few weeks later I started experiencing changes all over me as the Dr assured me that I have cured, after some time I went to my doctor to confirmed if I have be finally healed behold it was TRUE, So friends my advice is if you have any type of sickness or Relationship problem you can email Dr. Odidi on (odidispelltemple@gmail.com Or whatsApp +2349077057670. you can check his website www.odidispelltemple.blogspot.com