Symptom Recognition as a Mediator in the Self-Care of Chronic Illness

Barbara Riegel; Maddalena De Maria; Claudio Barbaranelli; Maria Matarese; Davide Ausili; Anna Stromberg; Ercole Vellone; Tiny Jaarsma

doi:10.3389/fpubh.2022.883299

Symptom Recognition as a Mediator in the Self-Care of Chronic Illness

Front Public Health. 2022 May 17:10:883299. doi: 10.3389/fpubh.2022.883299. eCollection 2022.

Authors

Barbara Riegel¹, Maddalena De Maria², Claudio Barbaranelli³, Maria Matarese⁴, Davide Ausili⁵, Anna Stromberg⁶, Ercole Vellone², Tiny Jaarsma⁷

Affiliations

¹ School of Nursing, University of Pennsylvania, Philadelphia, PA, United States.
² Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
³ Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
⁴ Research Unit of Nursing Sciences, Campus Bio-Medico University of Rome, Rome, Italy.
⁵ Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
⁶ Department of Health, Medicine and Caring Sciences, Department of Cardiology, Linkoping University, Linköping, Sweden.
⁷ Department of Health, Medicine and Caring Sciences, Linkoping University, Linköping, Sweden.

Abstract

Background: The recognition of a symptom is needed to initiate a decision to engage in a behavior to ameliorate the symptom. Yet, a surprising number of individuals fail to detect symptoms and delay in addressing early warnings of a health problem.

Purpose: The aim of this study was to test the hypothesis that symptom recognition mediates the relationship between monitoring for and management of symptoms of a chronic illness.

Methods: A secondary analysis of existing cross-sectional data. A sample of 1,629 patients diagnosed with one or more chronic conditions was enrolled in the United States (US) (n = 407), Italy (n = 784) and Sweden (n = 438) between March 2015 and May 2019. Data on self-care monitoring, symptom recognition, and self-care management was assessed using the Self-Care of Chronic Illness Inventory. After confirming metric invariance in cultural assessment, we used structural equation modeling to test a mediation model where symptom recognition was conceptualized as the mediator linking self-care monitoring and self-care management with autonomous (e.g., Change your activity level) and consulting behaviors (e.g., Call your healthcare provider for guidance).

Results: Symptom recognition mediated the relation between self-care monitoring and autonomous self-care management behaviors (β = 0.098, β = 0.122, β = 0.081, p < 0.001 for US, Italy, and Sweden, respectively). No mediation effect was found for consulting self-care management behaviors.

Conclusion: Our findings suggests that symptom recognition promotes autonomous self-care behaviors in people with a chronic condition. Self-care monitoring directly affects consulting self-care management behaviors but not through symptom recognition. Further research is needed to fully understand the role of symptom recognition in the self-care process.

Keywords: chronic disease; chronic illness; interoception; mediation analysis; self-care; self-management; symptom perception; symptom recognition.

MeSH terms

Chronic Disease
Cross-Sectional Studies
Health Personnel*
Humans
Referral and Consultation
Self Care*