Relation of Schedules to Chronic Illness Self-Care

Title: The relation of schedules to chronic illness self-care

Faculty Member(s):  Ron Coffen, PhD., Licensed Psychologist

Keywords: chronic illness; children; adolescents; self-care; self-management; adherence; compliance

Areas: clinical psychology, health psychology, child psychology, adolescent psychology, parenting


Research on chronic illnesses in children and adolescents shows that youths’ compliance with the medical regimen required to maintain optimal health is often poor, placing youth at risk for negative health consequences and even death.  Research consistently finds that adolescents in particular are poor adherers to medical regimens required by chronic illnesses such as type 1 diabetes, asthma, cystic fibrosis, juvenile rheumatoid arthritis and others.

Research on interventions that lead to improved adherence has often been challenged to demonstrate anything more than modest improvements in self-care among youth even after interventions.  Various hypotheses and models have been put forth to explain this resistance to self-management of illness among youth.

One of the most intriguing and promising models of health behavior is the Theory of Reasoned Action model which builds on the self-regulation model based on social cognitive theory (Bandura). The Theory of Reasoned Action has been extended to explain how actions do not have to remain under cognitive control every time the action is required—it describes how health behaviors can become habits and therefore do not require cognitive processing in every instance. If healthful behaviors become habits, self-care will increase and so will the positive health outcomes associated with adherence to a medical regimen for chronic illness.

Aarts, Paulussen and Schaalma (1997) offer an explanation of how habits develop.  The explanation includes a description of how environmental cues come to be associated with healthful actions and thus become habits. This idea implies that when environmental cues occur consistently, so will healthful self-care. Thus, it stands to reason that schedules and routines would create regular environmental cues that would lead to regular association with healthful self-care and thus better health outcomes.  However, no research that I’m aware of has examine whether or not families of children with chronic illnesses who follow routines and schedules have children in better health than families who do not have routines and schedules.  (Think of Super Nanny!  What is the first change she makes in nearly every house where the children are behaviorally disruptive?  She makes a schedule and behaviors improve!)

I would be interested in exploring the association between family routines and schedules with health outcomes for children with chronic illnesses.  In particular, I’d be interested in examining youth with type 1 diabetes.

References:  (Click on article to review)

Aarts, H., Paulussen, T., & Schaalma, H. (1997). Physical exercise habit: On the
conceptualization and formation of habitual health behaviors. Health Education Research, 12(3),

Cameron, K. & Gregor, F. (1987). Chronic illness and compliance. Journal of Advanced Nursing, 12(6), 671-676.

Clark, N. M., & Valerio, M. A. (2003). The role of behavioural theories in educational interventions for paediatric asthma. Paediatric Respiratory Reviews, 4(4), 325-333.

Coffen, R. D. (2009). The 600-step program for type 1 diabetes self-management in youth: The magnitude of the self-management task. Postgraduate Medicine, 121(5), 119-139. doi: 10.3810/pgm.2009.09.2059

Drotar, D., Riekert, K. A., Burgess, E., Levi, R., Nobile, C., Kaugars, A. S., & Walders, N. (2000). Treatment adherence in childhood chronic illness: Issues and recommendations to enhance practice, research, and training. In Dennis Drotar (Ed.), Promoting adherence to medical treatment in chronic childhood illness: Concepts, methods, and interventions (pp. 455-478). Mahwah, N.J.: L. Erlbaum Associates.

Theunissen, N. C. M., & Tates, K. (2004). Models and theories in studies on educating and counseling children about physical health: A systematic review. Patient Education and Counseling, 55(3), 316–330. doi:10.1016/j.pec.2004.08.016