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An Exemplar of Middle-Range Theory Revision: Self-Care of Chronic Illness

The current featured ANS article is an open access article, which means it is permanently available for all readers.  The article is titled “Integrating Symptoms Into the Middle-Range Theory of Self-Care of Chronic Illness” authored by Barbara Riegel, PhD, RN, FAAN; Tiny Jaarsma, PhD, RN, FAAN; Christopher S. Lee, PhD, RN, FAAN; and Anna Stromberg, PhD, RN, FAAN. Their article provides insight into this specific middle-range theory, but also serves as an exemplar of theory development and revision. We are eager to know your comments and responses to their work!  Here is a message from Dr. Riegel about their work:

Barbara Riegel

The purpose of our theoretical refinement was to disambiguate relationships between symptoms and the behaviors of self-care maintenance, monitoring and management within Middle-Range Theory of Self-Care of Chronic Illness. Since the Middle-Range theory was first published in 2012, our group has received a lot of positive feedback and the theory has been used extensively. We also have had external requests from investigators and even federal institutions about how to harmonize insights from theories focused on self-care with those focused on symptoms. Moreover, and as part of the theory-data process of theoretical refinement, we also had internal motivation to provide clarity on aspects of the theory related to symptoms.

Salient new themes explicated in this theoretical revision include that symptoms can be viewed as being part of self-care (e.g. the appraisal, detection and interpretation of bodily

Tiny Jaarsma

changes as symptoms are essential to self-care monitoring), as barriers or facilitators of self-care (e.g. motivate or blunt self-care behaviors), as outcomes of self-care (e.g. optimal symptom control), or in interaction with self-care of (e.g. moderation) depending on the research question being posed. Further, the interpretation of bodily changes as symptoms is complex and prone to heterogeneity such that multiple clinical phenotypes likely exist in how patients can engage in self-care monitoring and management.

We learned a great deal from one another and from the work of several other self-care and symptom scientists in this process, and are excited to see how the revised theory will be used to help guide innovative research. Please follow us at:


Christopher S. Lee

Anna Stromberg

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