An Update to the Middle-Range Theory of Self-Care of Chronic Illness

BACKGROUND: Self-care is essential in the management of chronic illness. In 2012, we published a middle-range theory addressing self-care as a process of maintaining health through health-promoting practices and managing chronic illness. Three key concepts in the theory were self-care maintenance, self-care monitoring, and self-care management. Self-care maintenance refers to those behaviors performed to improve well-being, preserve health, or maintain physical and emotional stability. Self-care monitoring is the process of routine vigilant surveillance, self-awareness, and body monitoring or body listening. Self-care management involves the response to signs and symptoms when they occur. In 2019, we updated the theory, specifying the important contribution of symptoms to self-care. Assumptions and propositions of the theory were specified in the original publication; both are expanded in this update.

PURPOSE: Here, we update the theory to reflect changes in our thinking and what has been learned from published literature and discussions with others. An important addition is a detailed discussion of 6 essential intrapersonal requirements for self-care: experience, knowledge, skills, reflection, decision-making, and motivation. These requirements interact dynamically; the order in which they are presented is not meant to reflect the order in which they are developed.

IMPLICATIONS FOR PRACTICE AND RESEARCH: These factors are particularly important in guiding the development of self-care interventions. Readers can now refer to this version instead of the 2012 publication.