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

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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.