Why We Need to Think Differently About Self‐Care and Self‐Management

As the prevalence of chronic conditions continues to rise globally, self-care and self-management are frequently promoted as central components of chronic disease care, shaping policy frameworks and healthcare delivery models, including the Chronic Care Model (Narasimhan et al. 2019; Wagner et al. 1996). Within nursing, self-care has long been foundational, reflected in Orem's Self-Care Deficit Theory (Orem 1971) and Riegel's Middle-Range Theory of Self-Care of Chronic Illness (Riegel et al. 2012). The World Health Organization (2022) defines self-care as ‘the ability of individuals, families, and communities to promote health, prevent disease, and cope with illness and disability, with or without the support of a health worker’ (p. xiii). Self-management, in contrast, is defined as ‘the intrinsically controlled ability of an active, responsible, informed, and autonomous individual to manage the medical, role, and emotional consequences of [their] chronic condition(s) in partnership with [their] social network and healthcare provider(s)’ (Van de Velde et al. 2019, 10). While self-care encompasses a broad spectrum of health states and behaviours, self-management is more narrowly framed in relation to chronic disease management (Lawless et al. 2021). However, the dichotomy between self-care and self-management is often misleading. Rather than treating them as separate constructs, self-care should be understood as a foundational concept integrating both person-centred care and population health approaches, addressing the social determinants of health and expanding nurses' role to integrated system-level interventions. Self-management, in turn, can be seen as an extension of self-care, particularly in the context of chronic illness. Effective self-carers and self-managers are expected to have adequate knowledge, engage in preventive and illness-management behaviours, and navigate changing care needs. These activities range from basic self-care (e.g., hygiene, nutrition, physical activity) to preventive measures (e.g., vaccinations, screenings) and chronic disease management (e.g., medication adherence, symptom monitoring). Despite extensive research, evidence on self-care and self-management intervention effectiveness remains inconclusive, reflecting not only methodological issues but also the failure to account for broader systemic and socioeconomic barriers (Lee et al. 2022). Key barriers include poverty, homelessness, migration and social isolation, which limit access to healthcare and essential resources (Iovino et al. 2024); gendered caregiving roles, which often create unequal expectations and burdens, particularly for women, who navigate dual responsibilities of self-care and caregiving for others (Yan et al. 2024); and mental health conditions, which can impair decision-making, motivation and overall self-care capacity (Whiteman et al. 2016). Neglecting these intersecting socioeconomic and life-course factors risks reinforcing health disparities and worsening chronic disease outcomes. While social determinants of health are central to models such as the Social-Ecological Model (Fisher et al. 2005), there is a need for a stronger theoretical foundation that positions nurses as key agents in addressing social determinants of health and coordinating care at multiple levels. To develop more effective and equitable approaches, we propose reframing self-care and self-management as interconnected processes operating across multiple levels simultaneously: micro level: individual needs, behaviours and capabilities; meso level: social networks, community resources and healthcare providers; and macro level: health systems, policies and structural influences. This perspective highlights the socially situated, relational and evolving nature of self-care and self-management, emphasising that interpersonal relationships and system-level structures must be considered by nurses and healthcare teams when supporting patients and carers. Although acknowledging the biopsychosocial dimensions of chronic disease care is by no means new (Corbin and Strauss 1985; Thorne 1993), our approach explicitly integrates self-care philosophy, rooted (mostly) in nursing discourse, with the more biomedically dominated self-management approach. Both must be situated within a broader social system and community framework to be effective. A coordinated approach across individual (micro), social (meso) and system (macro) levels is essential for developing sustainable, effective and equitable self-care and self-management strategies. A multi-level framework provides the necessary scaffolding to assess and coordinate support for self-care and self-management across the micro, meso and macro levels. This relational and dynamic approach acknowledges that self-care and self-management are not solely individual responsibilities but rather shared, socially embedded processes that require collaboration across healthcare and community settings. Nurses are well positioned to take on leadership and boundary-spanning roles, bridging gaps between individuals, healthcare providers and broader support systems. These roles involve advocacy, care coordination, education and system navigation to improve health outcomes. Additionally, nurses have a critical role in facilitating patient engagement and shared decision-making, ensuring self-management support is person-centred and contextually relevant. An emerging example of this expanded role is the nurse navigator, now widely recognised in integrated healthcare systems (Coyne et al. 2020). Originally developed in oncology care, nurse navigators are increasingly involved in supporting people with various chronic conditions, acting as a pivotal point of contact to help individuals access health and social care services across tertiary and primary care sectors (Chan et al. 2023). These advanced practice roles offer an opportunity to enhance care coordination, strengthen patient–provider relationships and facilitate cross-sector collaboration. Building on the work of Riegel et al. (2021), we propose four priority areas for future research to move nursing practice forward, leveraging advanced roles that embrace both person-centred care and population health approaches. These areas highlight the need for inclusive, sustainable and adaptable strategies that move beyond individual responsibility for effective self-care and self-management of chronic illness to consider relational and structural influences. Historically, self-care and self-management have been framed as individual responsibilities, emphasising individual autonomy and decision-making. Yet, growing research highlights how social, environmental and systemic factors influence health behaviours and access to formal and informal resources. This perspective aligns with a broader shift in healthcare, moving from disease-focused biomedical models to person-centred, socio-ecological approaches. Models such as the Care 4.0 paradigm (Chute and French 2019) and the diabetes initiative of the Robert Wood Johnson Foundation (Fisher et al. 2005) advocate for co-managed, community-supported healthcare, emphasising culturally tailored interventions, peer-led programs and digital health tools to improve engagement and reduce strain on healthcare systems. Similarly, the WHO identifies self-care as a key strategy for achieving universal health coverage, emphasising its role in improving access through comprehensive health and social care systems (Narasimhan et al. 2019). Future research should focus on bridging the gap between individual agency and structural influences, ensuring that self-care and self-management are conceptualised as both personal and social processes. Establishing a robust evidence base that reflects this broader paradigm is essential for developing policies and interventions that support an integrated, equity-driven strategy rather than standalone behavioural responsibility. In this context, nurse navigation models may offer useful insights. Their integration into chronic disease care models can enhance individual agency and system-level accessibility through structured guidance, advocacy and care coordination. A life-course approach recognises that care needs, behaviours, resources and preferences evolve over time. Designing adaptive, personalised interventions that remain effective and sustainable across different life stages, care transitions and socioeconomic contexts is essential. For example, cancer survivors benefit from personalised care plans that evolve as they transition from treatment to survivorship, requiring adjustments in symptom management, psychosocial support and lifestyle modifications (Rimmer et al. 2021). Similarly, patients with congestive heart failure experience shifting informational needs, requiring tailored stage-specific education (Ibrahim et al. 2016). Future research should prioritise longitudinal studies to track how self-care and self-management behaviours change over time, ensuring interventions remain relevant, flexible and responsive to evolving needs. Additionally, research should explore individualised care pathways that integrate biological, psychological and social factors to optimise long-term engagement. With advancements in digital health, future studies should investigate how telehealth, wearable devices and AI-driven analytics can support adaptive interventions (Xie et al. 2021). Embedding a life-course approach into clinical care and health policy is essential for developing sustainable frameworks that extend beyond one-time interventions. By integrating navigation approaches into life-course frameworks, healthcare systems can facilitate care transitions and improve continuity in self-care and self-management support across different life stages. Self-care and self-management are socially embedded practices, shaped by formal and informal support networks. These networks play a critical role in supporting individuals in managing their health. Theories such as the Caring Life-Course Theory (Kitson et al. 2022) emphasise that both the composition of a person's care network and the quality of their relationships influence the effectiveness of self-care and self-management strategies. Research on chronic disease management has shown that individuals with diverse, well-connected care networks experience better health outcomes, as strong ties facilitate access to resources, emotional support and practical assistance (Vassilev et al. 2016). Beyond traditional support systems, digital tools present new opportunities to enhance socially connected self-care and self-management. For example, the Generating Engagement in Network Involvement (GENIE) tool maps and expands patients' care networks, reducing social isolation and improving engagement with health resources (Kennedy et al. 2016). Online communities and support groups provide individuals with access shared experiences, information support and emotional encouragement (Allen et al. 2020). Future research should move beyond individual-centric models and adopt social network analysis to examine how different network structures impact self-care and self-management capacity. Network-based interventions could be designed to adapt to individuals' existing social supports, rather than assuming individuals with varying levels of support have the same capacity for independent self-care. Additionally, studies should assess how strong care networks—including peer-led and community-based interventions—can reduce reliance on healthcare services and improve long-term health outcomes. Understanding how these networks evolve over time, and how nurse navigators or other integrated nursing roles can facilitate these transitions will be critical in designing sustainable, economically viable, socially embedded interventions that help individuals better access and utilise their social networks. To reduce health disparities and promote equity, research needs to consider the diverse experiences of individuals across different social and cultural contexts. Health disparities disproportionately impact racial and ethnic minorities, LGBTQ+ individuals, people with disabilities and those facing language and socioeconomic barriers. Adopting a health equity lens can improve health outcomes by identifying and reducing barriers faced by marginalised groups. Studies show that equity-oriented care, prioritising accessibility, cultural sensitivity and responsiveness to social determinants of health, can lead to better self-rated health outcomes (Browne et al. 2024). Equity-focused interventions help mitigate experiences of stigma and discrimination, which often prevent individuals from accessing support and engaging consistently in self-care and self-management (Ford-Gilboe et al. 2018). Future research and policy efforts should prioritise community-driven, culturally relevant approaches that reduce barriers and improve patient engagement. Expanding health promotion interventions that incorporate targeted outreach, community-engagement and family-centred models can further support underserved populations (Persaud et al. 2023). Research should embrace a life-course, relational and intersectional approach to understand how gender, age, mental health and socioeconomic status, among other factors, intersect to shape self-care and self-management (Stutzin Donoso 2024). Navigation and related models may have a vital role in advancing health equity by addressing system-level barriers, advocating for structurally disadvantaged individuals, and enhancing access, continuity and culturally responsive support within equity-focused interventions. A multi-level perspective ensures self-care and self-management interventions are practical, responsive and sustainable, drawing on personal, social and systemic resources. A strong empirical foundation is needed to bridge micro-level patient experiences, meso-level care networks and macro-level care systems, enabling nursing roles to evolve to support growing populations with chronic conditions and underserved groups experiencing fragmented care. By adopting a dynamic, relational and life-course approach, we can move beyond individualistic models and develop contextually relevant strategies that reflect the complexities of caring work. Nurses have a central role in advancing self-care and self-management through experimenting with and testing new boundary-spanning and integrated roles such as the nurse navigator, building on practices that are already a hallmark of their profession. As frontline healthcare providers, they are uniquely positioned to bridge the gap between individual efforts and broader systemic support, ensuring that self-care and self-management are not framed as individual responsibilities but as part of a collective, integrated approach to care that promotes equity and continuity. We would like to thank Professors Barbara Riegel and Sally Thorne for their constructive feedback on earlier drafts of this commentary. The authors declare no conflicts of interest. The authors have nothing to report.