Date of Award

August 2019

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Nursing

First Advisor

Rachel F Schiffman

Second Advisor

Kate R Lorig

Committee Members

Kathleen J Sawin, Allice F Yan, Julie L Ellis

Keywords

Chronic Disease, Chronic Disease Self-Management Program, Depressive Symptoms, Medication Self-Management, Quality of Life, Stress

Abstract

MEDICATION SELF-MANAGEMENT BEHAVIORS OF COMMUNITY- DWELLING

ADULTS WITH CHRONIC DISEASE

by

Michelle Y. Williams, PhD, MSN, RN

The University of Wisconsin-Milwaukee, 2019

Under the Supervision of Professor Rachel Schiffman, PhD, RN, FAAN

Chronic conditions threaten public health, individuals, and families and affect all areas of a person’s life and require significant self-management from the individual with the disease, care from the healthcare provider and team, and support from the individual’s family. The relationship of selected risk and protective factors and communication with healthcare providers to medication self-management behaviors and quality of life was examined in 616 adults with chronic disease in this secondary analysis of the Stanford University Chronic Disease Self-Management Program. Data were collected at baseline and at 6 and 12 months after enrollment. On average, the sample was 68 years of age, female, with 2 chronic diseases. About 95% reported being of non-Hispanic ethnicity. Less than 20% were Black/African American and more than 95% had healthcare insurance. Depressive symptoms were found to be significantly correlated with medication self-management behaviors and quality of life at baseline, 6 and 12 months after enrollment. In contrast, stress was only found to be significantly correlated with medication self-management behaviors at 12 months and with quality of life at baseline and 12 months after enrollment. Conversely, communication with physicians was not found to be associated with medication self-management behaviors or with quality of life at any time point. Depressive symptoms were the strongest predictors of both medication self-management behaviors and quality of life at all measurement points. Together, these findings suggest that community-dwelling adults with chronic disease who experience depressive symptoms and stress were more likely to report less medication self-management behaviors and poorer quality of life. There are implications for further research on communication with physicians to understand the relative value on patient outcomes. The implications for practice include potential application of the Individual and Family Self-Management Theory and aspects of the Stanford University Chronic Disease Self-Management model to care nursing practice.

Keywords: medication, self-management, chronic disease, stress, depressive symptoms, quality of life

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