Self-as-doer and health promotion for patients with chronic disease

This scoping review aims to investigate the role of the self-as-doer construct, a psychological determinant gaining recognition for explaining and sustaining health-promoting behaviors, in health promotion among patients with chronic diseases. The aim of this scoping review is to investigate the role of self-as-doer construct in health promotion among patients with chronic diseases. Following Arksey and O'Malley's (2005) framework and the PRISMA-ScR guidelines, a systematic search was conducted across PubMed, Scopus, and Google Scholar for English-language publications up to June 2025. The search strategy utilized keyword combinations, such as "self-as-doer," "doer identity," "agentic identity," "self-identity," "health behavior," "lifestyle behavior," "self-care behavior," and "behavioral health." Studies were included if they were peer-reviewed, empirical (quantitative or qualitative) and published in English, and explicitly examined the self-as-doer concept in relation to health behaviors. Conversely, non-peer-reviewed publications, theoretical articles without original data, and studies outside the health context were excluded. Two reviewers independently screened studies and performed thematic analysis. Of the 157 records initially identified, four studies met the final inclusion criteria. These included an intervention trial (Brouwer and Mosack, 2015) with 124 women focusing on diet; a cross-sectional survey of 330 diabetes patients (Brouwer and Mosack, 2012) examining self-care behaviors; an experimental study (Brouwer, 2020) with 220 university students on physical activity; and a cross-sectional instrument-validation study (Brouwer and Mosack, 2013) focused on diabetes management. The findings were categorized into three main thematic areas: diet, self-care, and physical activity. Findings suggest that a strong self-as-doer identity is positively associated with engagement in health-promoting behaviors among patients with chronic illnesses. Nonetheless, several limitations were evident across the literature, including the small number of available studies, limited sample diversity, and short follow-up periods. Due to the nascent nature of the "self-as-doer" concept within health fields, the literature on this topic is limited yet growing. Strengthening the self-as-doer identity appears to enhance intrinsic motivation and adherence to health-promoting behaviors. At the policy level, embedding this psychological approach into public health strategies and campaigns could improve long-term health outcomes at both the individual and community levels.