Naturalistic Decision-Making Patterns in Cardiometabolic Multimorbidity Self-Care: A Qualitative Study

Area of Science:

• Cardiology
• Metabolic Health
• Primary Care Research
• Qualitative Health Research

Background:

• Self-care is crucial for managing cardiometabolic multimorbidity.
• Primary care clinicians need better insight into patient self-care decision-making.
• Understanding daily self-care navigation is essential for effective patient support.

Purpose of the Study:

• To explore self-care decision-making contexts, processes, and patterns in patients with cardiometabolic multimorbidity.
• To inform family medicine practice by understanding patient self-care behaviors.
• To identify how patients with multiple chronic conditions manage their health daily.

Main Methods:

• Qualitative cohort study using naturalistic decision-making theory.
• 27 adults with cardiometabolic multimorbidity were interviewed face-to-face.
• Thematic and narrative analysis within a context-mechanism-outcome framework was employed.

Main Results:

• Self-care decisions occurred in contexts of uncertainty, including symptom management, health crises, and emotional distress.
• Four decision-making patterns were identified: experience-anchored, values trade-off, passive-reactive, and proactive-integrative.
• 134 self-care decision-making chains were analyzed to identify these patterns.

Conclusions:

• Patients with cardiometabolic multimorbidity exhibit four distinct self-care decision-making patterns.
• Recognizing these patterns can enhance family physician communication and shared goal setting.
• Supporting patient self-efficacy through resource linkage can improve person-centered care for cardiometabolic multimorbidity.