Theory of self-care of chronic illness

Contributor – Barbara Riegel
December 20, 2020


Barbara Riegel, PhD, RN, FAAN
Tiny Jaarsma, PhD
Anna Stromberg, RN, PhD

First published – 2012

The process of self-care involves three core elements of self-care maintenance, monitoring, and management. These processes are interrelated and thought to be mastered in sequence.

Major Concepts

  • Self-care maintenance
  • Self-care monitoring
  • Self-care management

Typology – middle range theory

Brief Description

Self-care is essential in the management of chronic illness, but the process of engaging in self-care is more complex than originally thought. We define self-care as a process of maintaining health through health promoting practices and managing illness. We divide the process into three interrelated elements labeled as self-care maintenance, self-care monitoring, and self-care management. Self-care maintenance, performed in healthy and illness states, involves all those behaviors used to keep oneself healthy – getting a good night sleep, taking prescribed medication, exercise, etc. Self-care monitoring is a process of routine, vigilant body monitoring, surveillance, or “body listening”. Self-care management involves an evaluation of changes in physical and emotional signs and symptoms to determine if action is needed. These changes may be due to illness, treatment, or the environment.

Primary Sources

Riegel, B., Jaarsma, T., Stromberg, A. (2012). A Middle-Range Theory of Self-Care of Chronic Illness. Advances in Nursing Science, 35(3):194-204. PMID: 22739426. DOI: 10.1097/ANS.0b013e318261b1ba.

Riegel, B., Jaarsma, T., Lee, C.S., Stromberg, A. (2019). Integrating Symptoms into the Middle-Range Theory of Self-Care of Chronic Illness. Advances in Nursing Science, 42(3), 206-215. PMID: 30475237. PMCID: PMC6686959. DOI: 10.1097/ANS.0000000000000237.

Web: International Center for Self-Care Research

Application Source

Jaarsma, T., Cameron, J., Riegel, B., Stromberg, A. (2017). Factors related to self-care in heart failure patients according to the middle-range theory of self-care of chronic illness: a literature update. Current Heart Failure Reports, 14(2), 71-77. PMID: 28213768. DOI: 10.1007/s11897-017-0324-1.

About the Authors

Barbara Riegel  (1950 – )

Barbara Riegel, PhD, RN, FPCNA, FHFSA, FAHA, FAAN is the Edith Clemmer Steinbright Professor of Gerontology at the University of Pennsylvania School of Nursing and Co-Director of the International Center for Self-Care Research. Her research interests are in self-care broadly defined to include treatment adherence, condition monitoring, and self-management of symptoms. Dr. Riegel began studying these issues early in her career while a Clinical Researcher in an acute care setting when hospitals were just beginning to recognize that heart failure was a primary reason for hospital readmissions. She has developed theory and self-report measures of self-care that are used worldwide. Dr. Riegel has received numerous honors and awards including the Distinguished Scientist Award from the American Heart Association, Sigma Theta Tau International Nurse Researcher Hall of Fame, and the Barbara J. Lowery Award from the Doctoral Student Organization at the University of Pennsylvania.

Tiny Jaarsma (1964 – )

Prof. Dr. Tiny Jaarsma is a professor in nursing science at Linköping University, Sweden and the University Medical Centre Utrecht, the Netherlands. Her research focuses on the consequences of heart failure for patients and their families and developing and testing interventions to enhance their self-care. Results are published in in over 400 publications ranging from short practical communications to scientific publications in peer reviewed journals.

Tiny Jaarsma was trained as a nurse in Groningen, (NL) and she worked with cardiac patients since 1988, on the cardiology ward and in the Heart Failure clinic. She received her master degree from the University of Maastricht in 1992, she studied 6 months at the UCLA and completed her doctoral degree in 1999, with a thesis entitled “heart failure: nurses’ care.

She was the co-developer of The European Heart Failure Self-care Behaviour scale that is currently translated available in 20 languages and used in clinical research trials to evaluate the effect of nursing interventions as well as used and tested in nursing practise to improve the quality of the patient education by nurses.

Anna Stromberg (1967 – )

I am a professor at Linköping University, Sweden, an adjunct professor at University of Southern Denmark and has been a visiting professor at University of California Irvine. I have long experience of international research collaboration working mainly with researcher in the US and Europe. At present, I lead two large research programs. One national program entitled “Information and communication technology to support self-care in chronic illness” and one international called “User driven innovation: Symptom monitoring after hospitalization in patients with advanced heart failure” and I am a co-PI of a Danish research program entitled called “Heart and Mind” investigating different angles of psycho-cardiology including studies on the relationship between, anxiety and cardiac outcomes, effects of CBT on anxiety in persons with cardiovascular disease, Takotsubo/MINCA pathogenesis and relations with mental illness and distress. I am also a co-PI of a Norwegian project “Nurse Assisted eHealth Service from Hospital to Home: Ameliorating Burden of Treatment among Patients with Non-Communicable Diseases”.

At present my three main research tracks are: (A) interventions using eHealth and mHealth tools to reduce psychological stress and burden in family caregivers, (B) interventions using tele-rehabilitation to improve physical activity in elderly with long-term illness, (C) evaluations of different types of multidisciplinary disease management programs, (D) developing theory and instruments to measure self-care and participation in care.

I work with a broad range of designs mainly randomized controlled trials, but also observational and epidemiological studies. I have published around 250 scientific papers in peer-review journals including research articles, state-of-the-art papers, systematic reviews, and international guidelines.