Self-management interventions in the digital age: New approaches to support people with rheumatologic conditions

Self-management interventions are considered a key component of rheumatologic care. Access to these programmes, however, is an issue for some patients, especially those working full time or living in rural and remote communities. Recently, there has been an increase in the use of digital media technologies to deliver self-management interventions. Digital media (e.g., websites, mobile applications, social networking tools, online games and animation) provide tremendous flexibility for delivering health information and resources at a time and place that is chosen by the individual; hence, they are consistent with the patient-centred approach. This review discusses: (1) innovations in self-management interventions for patients with arthritis and (2) research in the use of digital media for delivering self-management interventions.

Musculoskeletal (MSK) conditions are the most common cause of severe chronic pain and disability worldwide . They consist of a multitude of conditions, varying from back and knee pain and common degenerative joint disease (e.g., osteoarthritis (OA)) to severe systemic inflammatory diseases, which damage joints and other organs (e.g., rheumatoid arthritis (RA) and lupus). Approximately 33% of US adults report having chronic joint symptoms/arthritis . In Canada, arthritis alone affects 4.4 million people (aged ≥15 years) and is projected to affect 7 million in 20 years . A similar trend has also been observed in Europe .

Current evidence indicates that patient education, especially with a cognitive behavioural component, can improve pain, physical function and self-efficacy in patients with arthritis . These interventions aim to provide knowledge, skills and resources for patients to engage in self-management activities. Most studies of self-management evaluate face-to-face programmes with patients in small groups or individual sessions but, in reality, access to these programmes is challenging to some. For example, those with a high level of pain and fatigue can be limited by these symptoms alone in attending such programmes. Also, interventions may not be accessible to those living in rural and remote communities. To reach those who are hard to reach, there has been an increasing use of digital media technologies to deliver self-management interventions.

Digital media , which are electronic media that operate on digital codes, offer a broad range of applications, such as social networking tools, online games, animation, interactive and personalised websites and video/audio recording. They provide tremendous flexibility for delivering health-related information at a time and place that is chosen by the individual. In the past, digital media referred to ‘new media’ for specific applications. Today, digital media is everywhere. With the rapid development of computerised programs and mobile devices, there are a growing number of studies examining the use of new technologies to deliver self-management interventions.

The purpose of this review is to describe recent innovations in self-management interventions for patients with arthritis. Specifically, we discuss: (1) the concept of self-management, (2) the role of digital media in supporting self-management in people with arthritis and (3) the current research on interventions delivered via digital media to engage patients in self-management activities. We focus on the use of Internet and mobile devices because they enable access to self-management interventions at a time and/or location chosen by the patient; hence, they are consistent with the patient-centred approach. The article concludes with recommendations for future research in the use of digital media technologies for supporting self-management.

The concept of self-management

The concept of self-management is not new ( Fig. 1 ). A recent paper by Kendall et al. suggested that examples of self-management activities have existed throughout history, with the earliest activities rooted in a political context. In the early 1500s, self-organising advocacy groups were present to defend the rights of the marginalised population against the ruling elite and the government. The application of self-management for maintaining health and well-being could be dated back to 1747 when John Wesley, founder of the Methodist Church, published books such as Primitive Physic: or, An Easy and Natural Method of Curing Most Diseases . Wesley aimed to help those who could not afford medical care to stay healthy by teaching ways to prevent illness and disability. His teaching, such as being physically active, eating healthy, practising proper hygiene and paying attention to mental health, is similar to what is covered today in self-management programmes. Integral to Wesley’s teaching was the implication that one could maintain good health and minimise suffering from disease through participation in self-care. The acceptance of Wesley’s publications by the public was not dissimilar to the current use of the Internet by patients to seek medical information. A large online survey of people with chronic disease in the USA ( n = 10 069), published in 2002, found that those who lacked insurance coverage or had poor access to care tended to use the Internet as a surrogate for medical advice .