Who's in charge? The role of responsibility attribution in self-management among people with chronic illness

ObjectiveTo explore how responsibility attribution influences self-management regimens among people with chronic illness.MethodsThis qualitative content analysis included 26 interviews with people living with chronic illness.ResultsThe participants attributed responsibility to internal, external or a combination of these factors, meaning that they either assumed responsibility for self-management or considered other people or factors responsible. Internal responsibility was associated with a multifaceted self-management regimen, whereas external responsibility was related to “conventional” self-management such as taking medication, managing symptoms and lifestyle changes.ConclusionHow responsibility is attributed is vital for the way in which individuals perform self-management. In this study, those who attributed responsibility to external factors mainly performed recommended behaviours to control their illness. In contrast, to take charge of their illness and be an active participant in the care, individuals must take responsibility for themselves, i.e. internal responsibility.Practice implicationsHealth-care providers should acknowledge and support individuals’ wishes about various levels of responsibility as well as different kinds of patient–provider relationships.