Abstract
ObjectiveSelf-management strategies are essential elements of evidence-based treatment in patients with chronic conditions in primary care. Our objective was to analyse different self-management skills and behaviours and their association to adult attachment in primary care patients with multiple chronic conditions.MethodsIn the apricare study (Adult Attachment in Primary Care) we used a prospective longitudinal design to examine the association between adult attachment and self-management in primary care patients with multimorbidity. The attachment dimensions avoidance and anxiety were measured using the ECR-RD. Self-management skills were measured by the FERUS (motivation to change, coping, self-efficacy, hope, social support) and self-management-behaviour by the DSMQ (glucose management, dietary control, physical activity, health-care use). Clinical diagnosis and severity of disease were assessed by the patients’ GPs. Multivariate analyses (GLM) were used to assess the relationship between the dimensions of adult attachment and patient self-management.Results219 patients in primary care with multiple chronic conditions (type II diabetes, hypertension and at least one other chronic condition) between the ages of 50 and 85 were included in the study. The attachment dimension anxiety was positively associated with motivation to change and negatively associated with coping, self-efficacy and hope, dietary control and physical activity. Avoidance was negatively associated with coping, self-efficacy, social support and health care use.ConclusionThe two attachment dimensions anxiety and avoidance are associated with different components of self-management. A personalized, attachment-based view on patients with chronic diseases could be the key to effective, individual self-management approaches in primary care.
Highlights
The attachment dimension anxiety was positively associated with motivation to change and negatively associated with coping, self-efficacy and hope, dietary control and physical activity
A personalized, attachment-based view on patients with chronic diseases could be the key to effective, individual self-management approaches in primary care
Supporting self-management in patients with multiple chronic diseases is of central importance in primary care
Summary
Supporting self-management in patients with multiple chronic diseases is of central importance in primary care. Patients scoring high on the avoidance scale have learned to suppress their attachment needs. They tend to evade emotional closeness and intimacy and have a tendency to feel uncomfortable about opening up to or depending on others. Patients scoring high on the anxiety scale have a hyper-activated attachment system. They tend to be preoccupied with others and have a tendency to fear rejection and abandonment [14]. The aim of this study was to identify the associations between adult attachment and self-management skills, and evaluate the self-management behaviour in patients with the multiple chronic diseases most common among elderly patients in surgeries of family physicians in Germany
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