Connecting Dots for Framing Health: The Self-Care Process

According to the Middle Range Theory of Self-Care of Chronic Illness, self-care refers to a process of maintaining health through health-promoting practices and managing illness when it occurs. Self-care is characterized by three sets of behaviors: self-care maintenance, self-care monitoring, and self-care management, discussed further below. Adequate self-care behaviors are the cornerstone of clinical pathways and care processes for persons with a chronic illness who are determined to stay healthy, namely, pointing out the current lively and heated debate surrounding the international research on self-care. Despite the generic nature of self-care as described in the theory and the availability of research instruments measuring the construct, very few researchers have applied the concepts of self-care in the field of CHD, highlighting the heterogeneous self-care behaviors performed by adults with congenital heart defects (ACHD). The fragmented results about self-care maintenance reveal that many ACHD patients smoking cigarettes, using marijuana or other illicit drugs at least once, and consuming alcohol. A significant number (40%) of the ACDH population are underweight or overweight (obese), and only 30% of ACHD patients engage in an optimal level of physical activity. One in every three ACHD patients did not receive the flu vaccine, and one in five ACHD patients reported poor adherence to ongoing medical treatment and follow-up visits. Self-care monitoring and self-care management have received very little attention in the field of ACHD patients. Self-care self-efficacy, shown as a determinant of self-care maintenance, self-care monitoring, and self-care management, was studied especially in the context of ACHD patients’ willingness to perform physical activity, demonstrating that ACHD patients had low levels of self-care self-efficacy.