Self-management approaches for individuals with multiple chronic health conditions in rural South Africa

慢性健康状况，包括非传染性疾病、精神障碍和艾滋病毒/艾滋病等某些长期传染病，已成为包括南非在内的低收入和中等收入国家发病和死亡的主要原因。这一日益加重的负担要求作出创新的反应。由于大多数慢性病的管理，包括服药、改变生活方式或采取预防行动，都是在家庭、社区和门诊环境中进行的，这涉及到患者、他们的护理人员或双方就采取何种行动做出日常决定。患者参与慢性病护理的管理被称为自我管理。自我管理有效的先决条件是自我监控，即“监控自己的状况，以影响认知、行为和情绪反应，以维持令人满意的生活质量的能力”。自我监测广义上包括对临床参数（如体重、血压、血糖和肺功能）、症状测量（如疲劳、压力和疼痛）和日常生活特征（如身体活动、饮食摄入和睡眠模式）的监测。自我监控的关键属性是：(i)对身体症状、感觉、日常活动和认知过程的意识；（ii）为认知提供信息并为独立行动或与护理提供者咨询提供信息的测量、记录或观察。众所周知，与健康有关的行为和做法在地理环境之间和在特定环境中的个人之间存在明显差异，对个人健康进行自我监测的情况也是如此。来自高收入环境的证据表明，自我监测个人健康可以改善自我管理、症状管理和疾病调节，并可减少并发症，改善患者的应对和对疾病的态度，制定切合实际的目标，提高生活质量。然而，目前尚不清楚在高收入环境中观察到的自我监测的好处是否、如何以及在多大程度上可以在低收入和中等收入国家，特别是在农村环境中实现。该项目旨在评估生活在南非农村的患有多种慢性疾病的个人自我监测健康的程度、他们使用的方法以及不同的自我监测方法对行为和健康结果的影响，以此作为改善患有多种慢性疾病的个人自我管理的基础。该项目的研究将在南非东北部姆普马兰加省阿金库尔街道的阿金库尔健康和社会人口监测系统研究区进行。收集数据的方式包括对40岁及以上患有慢性疾病的患者进行问卷调查，对患者和卫生保健专业人员进行访谈，以及与患者、护理人员和社区成员进行讨论。预计我们的研究活动将有助于有效解决南非以及东部和南部非洲其他农村地区农村人口中慢性疾病的多重发病率和随后的死亡率日益增加的负担。

Chronic health conditions, including non-communicable diseases (NCDs), mental disorders, and certain long-term infectious diseases such as HIV/AIDS have emerged as leading causes of morbidity and mortality in low and middle-income countries including South Africa (SA). This growing burden demands an innovative response. As most of the management of chronic diseases, which includes taking medication, making lifestyle changes, or undertaking preventive action occurs in homes, communities and outpatient settings, it involves patients, their carers or both making the day-to-day decisions about what actions to take. Involvement of patients in the management of their care for chronic diseases is referred to as self-management. A prerequisite for self-management to be effective is self-monitoring which is the "ability to monitor one's condition to effect the cognitive, behavioural and emotional responses necessary to maintain a satisfactory quality of life". Self-monitoring broadly includes the monitoring of clinical parameters (such as weight, blood pressure, blood glucose and lung function), symptom measures (such as fatigue, stress and pain) and features of daily life (such as physical activities, dietary intake, and sleep patterns). Key attributes of self-monitoring are: (i) awareness of bodily symptoms, sensations, daily activities, and cognitive processes and, (ii) measurements, recordings, or observations that inform cognition and provide information for independent action or consultation with care providers. As health-related behaviours and practices are known to be distinctly different between geographical settings and between individuals within a particular setting, similarly is the case of self-monitoring of personal health. Evidence from high income settings has demonstrated that self-monitoring of personal health can improve self-management, symptom management and disease regulation, and can lead to reductions in complications, improvement in patients' coping and attitudes toward their disease, realistic goal setting and an enhanced quality of life. However, it is unknown whether, how and the extent to which the benefits of self-monitoring observed in high income settings can be realised in low and middle-income countries especially in rural settings. This project aims to assess the extent to which individuals with multiple chronic health conditions living in rural South Africa self-monitor their health, what methods they use, and the effect of different self-monitoring approaches on behaviours and health outcomes - as a basis for improving self-management among individuals with multiple chronic health conditions. The research for the project will be conducted in the Agincourt health and socio-demographic surveillance system study area in Agincourt sub-district in Mpumalanga province, in northeast South Africa. Data will be collected using questionnaires administered to patients aged 40 years and older with chronic health conditions, interviews with patients and health care professionals, and discussions with patients, care givers and community members. Our research activities are expected to contribute to efforts to effectively tackle the rising burden of multimorbidity of chronic health conditions and subsequent mortality among rural populations in South Africa and other rural settings in East and Southern Africa.