Flourishing in chronic disease care: a narrative review and proposed conceptual framework

The growing burden of chronic diseases has increased interest in both psychological distress and positive psychological functioning among people living with chronic conditions. In this context, flourishing may be understood as the capacity to maintain positive functioning, meaning, social connectedness, and personal growth while adapting to long-term illness. This narrative review examines the conceptualization, theoretical foundations, current evidence, measurement instruments, and factors associated with flourishing in chronic disease populations. Insights from Keyes' Mental Health Continuum, the complete state model of mental health, the PERMA model, and evidence on contextual and psychological factors are integrated to propose a model-informed conceptual framework for future research and intervention development. The proposed framework emphasizes the complementary goals of reducing psychological distress and strengthening positive psychological resources, thereby broadening chronic disease care from symptom control toward patient-centred approaches that also support positive functioning, adaptation, and self-management. Further empirical research is required to evaluate the conceptual validity, feasibility, and applicability of this framework across chronic disease populations.