A model of integration of illness and self‐management in type 2 diabetes

Abstract

hörnsten å, jutterström L, Audulv Å & Lundman B (2011) Journal of Nursing and Healthcare of Chronic Illness 3 , 41–51 A model of integration of illness and self‐management in type 2 diabetes Aim. To describe the process of illness integration and self‐management among people with type 2 diabetes. Background. Integration of illness is a developmental process referring to the emotional and existential aspects of being ill. It is an overarching concept that describes the process that a person undergoes in living with a chronic disease, from prediagnosis to adaptation to illness as a natural part of life. Despite the common use of terms such as illness integration and self‐management, there exists little research that investigates how these concepts relate to one another. Methods. A narrative interview study applying qualitative content analysis was conducted with people diagnosed with type 2 diabetes. The study focused on their personal understandings of illness, and particularly, the relationship of the participants’ illness integration to self‐management of the disease. Data were collected in 2002. Results. In the trajectory from prediagnosis to adaptation, there is a turning point when people seem to integrate the illness emotionally and existentially, and in relation to their self‐management practice. The trajectory includes the phases of suspecting illness/being diagnosed, understanding and explaining the illness, and negotiating illness and taking stands about self‐management. These phases in turn are influenced by perceptions of the seriousness and threat of the disease; the intensity and nature of the ill person’s emotional response to the disease and its management; goals and expectations for living with the disease and for living in general; and lastly, perceptions of the outcomes and impacts of self‐management. Conclusion. Illness integration and self‐management processes develop simultaneously. In some cases, a turning point occurs that causes the person to view self‐management as both necessary and feasible. Relevance to clinical practice. Nurses may influence the illness integration trajectory and assist people with type 2 diabetes to integrate the disease and its management more readily.