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Research ArticleOriginal Research

Descriptions of Barriers to Self-Care by Persons with Comorbid Chronic Diseases

Elizabeth A. Bayliss, John F. Steiner, Douglas H. Fernald, Lori A. Crane and Deborah S. Main
The Annals of Family Medicine May 2003, 1 (1) 15-21; DOI: https://doi.org/10.1370/afm.4
Elizabeth A. Bayliss
MD, MSPH
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John F. Steiner
MD, MPH
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Douglas H. Fernald
MA
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Lori A. Crane
PhD, MPH
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Deborah S. Main
PhD
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    Figure 1.

    Schematic Representation of the Analytic Methodology

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    Table 1.

    Demographic Characteristics of Participants (n = 16)

    CharacteristicNumber of participants
    Female13
    Male3
    White16
    Age
        31–401
        41–503
        51–603
        61–704
        Older than 705
    Education
        High school graduate2
        Some college7
        College graduate5
        Post-college2
    Annual income
        < $15,0007
        $15,001–$30,0003
        $30,001–$45,0002
        $45,001–$60,0003
        No answer1
    Health insurance
        None4
        Medicare8
        Medicaid1
        Managed care2
        No answer1
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    Table 2.

    Disease Characteristics of Participants (n = 16)*

    CharacteristicNumber of participants†
    * Mean number of conditions, 4.3 (range, 3–7). Median number of conditions, 4.0.
    † Each of the following diagnoses was reported by one subject: arrhythmia, stroke, chronic sinusitis, varicose veins, neuropathy, alcoholism, incontinence.
    Medical condition†
    Osteoarthritis12
    Hypertension11
    Chronic bronchitis, emphysema, asthma7
    Diabetes5
    Other musculoskeletal diagnosis4
    Other psychiatric diagnosis4
    Vision problem4
    Coronary artery disease3
    Migraine3
    Obesity2
    Gastroesophageal reflux2
    Congestive heart failure1
    Depression, ever14
        Current treatment6
        No current treatment8
    Overall health status
    Excellent0
    Very good1
    Good7
    Fair7
    Poor1
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    Table 3.

    Potential Barriers to Self-care From Free-Listing Interviews

    Potential barrier to self-careNumber of participants citing category*Examples (quotations)
    COPD = Chronic obstructive pulmonary disease.
    *Mean number of barriers to self-care mentioned by respondents, 7.7 (range, 5–11).
    Compound effects of conditions14Can’t exercise for diabetes due to the breathing.
    Physical limitations/adaptations to limitations caused by conditions14Hard to get around and do what I used to.
    Compound effects of medications (therapeutic and side effects)9Medication for one affects another health problem.
    Schedule and coordination of medications9Hard to keep on top of needing different medications at different times.
    Total burden of medications6I don’t like taking all this medicine.
    Side effects of medications5Medicine for blood pressure makes me feel bad.
    Lack of knowledge about conditions8I didn’t know you could treat diabetes.
    Financial constraints8Need to pay for medicines ... financial issues.
    Low self-efficacy or sense of loss of control8Feel like I’m falling apart. This has been a bad year.
    Burden of the dominant effect of a single condition8Loss of vision is worse than COPD or arthritis.
    Emotional impact of diseases7List of problems makes me worry about health.
    Inadequate communication with providers7Not everybody is the same and needs the same treatment.
    Need for or use of social support7It’s a team effort between the two of us [husband and wife].
    Logistical issues3Have to go to the doctor more.
    Need for understanding conditions.3Society, parents, teachers need to try to understand chronic
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The Annals of Family Medicine: 1 (1)
The Annals of Family Medicine: 1 (1)
Vol. 1, Issue 1
1 May 2003
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Descriptions of Barriers to Self-Care by Persons with Comorbid Chronic Diseases
Elizabeth A. Bayliss, John F. Steiner, Douglas H. Fernald, Lori A. Crane, Deborah S. Main
The Annals of Family Medicine May 2003, 1 (1) 15-21; DOI: 10.1370/afm.4

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Descriptions of Barriers to Self-Care by Persons with Comorbid Chronic Diseases
Elizabeth A. Bayliss, John F. Steiner, Douglas H. Fernald, Lori A. Crane, Deborah S. Main
The Annals of Family Medicine May 2003, 1 (1) 15-21; DOI: 10.1370/afm.4
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