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

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.

Figure 1

The response to symptoms requires that the symptom is detected, presumably through the behaviors of self-care monitoring. Monitoring involves actively noticing typical symptoms and checking for the presence of bodily changes. Symptom detection precedes perception, which involves becoming consciously aware of the symptom. Once detected and perceived, interpretation and the assignment of meaning occurs, which leads to symptom recognition. Symptom recognition is required before a self-care management response can be expected to occur.

Figure 2

Graphic illustration of the way responses to this question can be analyzed.

Figure 3

Direct effects of self-care monitoring on autonomous and consulting self-care management behaviors are shown to occur via item #14 (symptom recognition) in a sample of patients from the United States, Italy, and Sweden (n = 1615). Note that the dashed arrow indicates the direct effects were not statistically significant. The error standard is shown in brackets. Key: SC-CII: Self-Care of Chronic Illness Inventory; a: p-value 0.05; b: p-value < 0.05; US, United States; ITA, Italy; SWE, Sweden.