Patterns of self-care decision-making and associated factors: A cross-sectional observational study

Christopher S. Lee, Kenneth E. Freedland, Tiny Jaarsma, Anna Strömberg, Ercole Vellone, Shayleigh Dickson Page, Heleen Westland, Sara Pettersson, Michelle van Rijn, Subhash Aryal, Andrew Belfiglio, Douglas Wiebe, Barbara Riegel

Research output: Contribution to journalArticlepeer-review


Objective: The aim of this study was to identify for the first time patterns of self-care decision-making (i.e. the extent to which participants viewed contextual factors influencing decisions about symptoms) and associated factors among community-dwelling adults with chronic illness. Methods: This was a secondary analysis of data collected during the development and psychometric evaluation of the 27-item Self-Care Decisions Inventory that is based on Naturalistic Decision-Making (n = 430, average age = 54.9 ± 16.2 years, 70.2 % female, 87.0 % Caucasian, average number of chronic conditions = 3.6 ± 2.8). Latent class mixture modeling was used to identify patterns among contextual factors that influence self-care decision-making under the domains of external, urgency, uncertainty, cognitive/affective, waiting/cue competition, and concealment. Multivariate multinomial regression was used to identify additional socio-demographic, clinical, and self-care behavior factors that were different across the patterns of self-care decision-making. Results: Three patterns of self-care decision-making were identified in a cohort of 430 adults. A ‘maintainers’ pattern (48.1 %) consisted of adults with limited contextual influences on self-care decision-making except for urgency. A ‘highly uncertain’ pattern (23.0 %) consisted of adults whose self-care decision-making was largely driven by uncertainty about the cause or meaning of the symptom. A ‘distressed concealers’ pattern (28.8 %) consisted of adults whose self-care decision-making was highly influenced by external factors, cognitive/affective factors and concealment. Age, education, financial security and specific symptoms were significantly different across the three patterns in multivariate models. Conclusion: Adults living with chronic illness vary in the extent to which contextual factors influence decisions they make about symptoms, and would therefore benefit from different interventions.

Original languageEnglish
Article number104665
JournalInternational Journal of Nursing Studies
StatePublished - Feb 2024


  • Decision-making
  • Self-care
  • Symptoms


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