Gender differences in self-management activation among patients with multiple chronic diseases: a qualitative study

Abstract

Gender; Multimorbidity; Patient activation; Qualitative; Self-Management

Gènere; Multimorbiditat; Activació del pacient; Qualitatiu; Autogestió

Género; Multimorbilidad; Activación del paciente; Cualitativo; Autogestión

Multimorbidity significantly affects patients' quality of life and poses a growing challenge for healthcare systems worldwide, particularly in ageing populations. Effective self-management is key to improving health outcomes, yet gender plays a crucial role in shaping patients' experiences and approaches to managing chronic conditions. This study aimed to explore gender differences in self-management among individuals living with multiple chronic diseases.

We conducted a qualitative phenomenological study using in-depth semi-structured interviews with 43 patients, purposively sampled to capture variation in age, socioeconomic background, and healthcare setting. Interviews explored experiences of self-management among both women and men, and data were analysed thematically to identify patterns across narratives. Thematic analysis was applied to the qualitative data, and findings were interpreted in alignment with the domains of the Patient Activation Measure-13 (PAM-13).

Six main themes emerged: personal responsibility, health literacy, self-management and decision-making, communication with healthcare professionals, adherence and treatment monitoring, prevention of complications, and lifestyle modifications. Importantly, gender differences significantly shaped patients' engagement with self-management across all thematic areas. Women generally demonstrated a more proactive approach, while men were more likely to depend on external support.

This study highlights distinct gendered approaches to chronic illness management. Women tended to actively engage in self-care and frequently took on informal caregiving responsibilities, pointing to the need for interventions that support shared decision-making and alleviate caregiver burden. In contrast, men were generally more reliant on others and less inclined to seek help, emphasizing the importance of fostering autonomy, enhancing health literacy, and encouraging early engagement with healthcare services. These findings underscore the value of gender-sensitive, patient-centred approaches in chronic disease management to improve health outcomes and reduce disparities.

This work was supported by a research grant from the Official College of Nurses of Lleida awarded under the 2022 call of the grant XII Beca COILL al Millor Projecte de Recerca Infermera and by the Department of Health of the Government of Catalonia within the framework of the Research and Innovation in Health Strategic Plan 2022–2027 [grant number SLT0035/24/000028].