1. Jaarsma, Tiny PhD, RN
  2. Riegel, Barbara PhD, RN, FAHA, FAAN
  3. Stromberg, Anna PhD, RN

Article Content

With the increasing interest in using the concept of self-care in research studies, the knowledge base for the different aspects of self-care has grown steadily. After the introduction of Orem's1 grand theory of self-care in 1971, other theories, models, and frameworks have addressed the process used by patients in performing self-care with the ultimate goal of improving outcomes. Although challenges around terminology and definitions exist,2 self-care is acknowledged as essential in the management of chronic illness.


Self-care can be defined as a process of maintaining health through health-promoting practices and managing illness.3 Self-care can be seen as an overarching concept built from the 3 key concepts of self-care maintenance, self-care monitoring, and self-care management. An increasing number of studies have used theories of self-care to guide the analysis in literature reviews, develop instruments to measure self-care, and develop and test interventions aimed at improving outcomes of patients with chronic diseases,4-8 as shown in the exponential increase in the number of publications on self-care (Figure).

FIGURE. Number of pu... - Click to enlarge in new windowFIGURE. Number of publications on self-care and chronic illness in PubMed from 1950 to 2016.

Ideally, this increasing amount of data would lead to an accumulated body of knowledge with regard to self-care. However, it is necessary to correctly interpret findings and then to combine data to reveal knowledge, transparency with regard to conceptual definitions, methods used and conclusions. Without such transparency, readers are left unclear about what is truly known and how to implement what is known into self-care interventions.


The Consolidated Standards of Reporting Trials 2010 statement and its extensions on reporting designs, interventions, or data, including several checklists, are helpful in standardizing reporting.9 These guidelines include those addressing the reporting of patient-reported outcomes (Consolidated Standards of Reporting Trials PRO) and the Template for Intervention Description and Replication checklist and guide. To improve the integration of knowledge related to self-care, we propose some additional basic guidelines when reporting on studies that include self-care as the conceptual or theoretical framework, an outcome measure, or the target of the intervention. These guidelines can be used in addition to the existing guidelines on reporting of research. The aim of the guideline presented hereinafter is to streamline reporting about self-care and to help future researchers to use findings from others in interpreting their own results. The clearer and more consistent a report is with regard to self-care, the easier and more complete it will be to compare results or to learn what the results really mean.


We suggest that the following elements be reported in all research addressing self-care:


Self-care and key concepts


1. How was self-care defined?


2. What theoretical framework was used to guide the study?


3. Which key concept(s) was (were) addressed in the study (eg, self-care maintenance, self-care monitoring, and self-care management or self-care agency, self-care deficit, etc)?


4. How is self-care measured, and which key concepts (eg, self-care maintenance, self-care monitoring, self-care management or self-care agency, self-care deficit, etc) are measured and how?Intervention and control


5. Which key concept(s) was (were) targeted with the intervention (eg, self-care maintenance, self-care monitoring, and self-care management or self-care agency, self-care deficit, etc)?


6. Which materials/methods were used in the self-care intervention (eg, teaching materials and techniques, technology, motivational interviewing, length of the intervention)?


7. What self-care support did patients in the control group receive (eg, peer groups, telephone follow-up, different types of technology)?Setting, sample, and follow-up


8. What (if any) self-care-related criteria were used to select participants (eg, self-care novice, experts, low or high self-care, dyad characteristic)?


9. On what data or previous study of self-care was the sample size calculated?


10. What was the setting of the study? What is the standard of care related to self-care in the setting under study?


11. What was the rationale for the follow-up intervals (eg, comparison with previous self-care studies)?Related factors and discussion


12. Which related factors are measured (eg, patient activation)?


13. How do your results contribute to the theory used?



The objective of this list is to provide a set of recommendations for reporting on trials including the concept of self-care. A checklist containing these items is available as Document, Supplemental Digital Content 1, Such a checklist can be used by future authors and by reviewers. It is an attempt to stimulate a more standardized, complete, and transparent approach to the design and reporting of research studies. We anticipate that the use of this list will aid in the critical appraisal and interpretation of self-care research.




1. Orem DE. Nursing: Concepts of Practice. New York: McGraw-Hill. 1971. [Context Link]


2. Miller WR, Lasiter S, Bartlett Ellis R, Buelow JM. Chronic disease self-management: a hybrid concept analysis. Nurs Outlook. 2015;63(2):154-161. [Context Link]


3. Riegel B, Jaarsma T, Stromberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci. 2012;35(3):194-204. [Context Link]


4. Buck HG, Harkness K, Wion R, et al. Caregivers' contributions to heart failure self-care: a systematic review. Eur J Cardiovasc Nurs. 2015;14(1):79-89. [Context Link]


5. Dickson VV, Lee C, Yehle KS, Abel WM, Riegel B. Psychometric testing of the self-care of hypertension inventory. J Cardiovasc Nurs. 2016. [Epub ahead of print]. [Context Link]


6. Boyde M, Peters R, Hwang R, Korczyk D, Ha T, New N. The self-care educational intervention for patients with heart failure: a study protocol. J Cardiovasc Nurs. 2015. [Epub ahead of print]. [Context Link]


7. Siabani S, Driscoll T, Davidson PM, Leeder SR. Efficacy of a home-based educational strategy involving community health volunteers in improving self-care in patients with chronic heart failure in western Iran: a randomized controlled trial. Eur J Cardiovasc Nurs. 2016;15(5):363-371. [Context Link]


8. Lambrinou E, Middleton N. Measures of self-care in heart failure: how methodological queries are translated into clinical ones? Heart Lung. 2015;44(1):83-85. [Context Link]


9. Hopewell S, Clarke M, Moher D, et al. CONSORT for reporting randomised trials in journal and conference abstracts. Lancet. 2008;371(9609):281-283. [Context Link]