Graduation Date

Summer 8-13-2021

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Bunny Pozehl

Second Advisor

Christine M. Eisenhauer

Third Advisor

Myra S. Schmaderer

Fourth Advisor

Fabio Almeida

MeSH Headings

Self-Care, Self Management, Multimorbidity, Comorbidity, Rural Population



Chronic diseases are the leading cause of death and disability in the United States and are on the rise. Multiple chronic conditions are increasing in frequency with 1 in 4 adults affected. Behaviors of adults from rural communities are at an increased risk of developing MCC because of limited access to health care resources and behaviors. Supporting the development of self-management skills can help adults be more active in their own health and promote healthy lifestyle behaviors. The Individual and Family Self-management was the guiding framework for this cross-sectional study.


The purpose of this study was to determine the self-management perceptions and behaviors of adults from rural communities diagnosed with multiple chronic conditions. The specific aims were to:

Aim 1: Determine the feasibility of recruitment, enrollment, and data collection in rural adults with MCC

Aim 2: Explore perceptions of SM needs of rural dwelling adults with MCC

Aim 3: Describe the SM variables of self-efficacy, self-regulation, social support, and patient activation and the SM behaviors of rural adults with MCC.


A descriptive cross-sectional design was used. Data collection methods includes surveys, medical records extractions, and two focus groups. Collection occurred between January and June 2021. A sample of 40 adults from isolated rural (RUCA 10) communities were enrolled in this study from primary care clinics in the Midwestern United States. Because of COVID-19 on health and safety protocols, participants were recruited by clinic staff, nurses, and providers. All contact with research personnel occurred through distance technology, either telephone or zoom web conferencing. Participants were enrolled and screened for inclusion, consented, and data collection virtually.

Data Analysis

Descriptive analyses, t-tests to compare sample means to the comparative means identified for each instrument, and spearman’s correlation to identify relationships between self-management processes and self-management behaviors of physical activity and sleep were conducted. Descriptive content analysis occurred for the focus groups. Two researchers worked collaboratively to refine coding into a matrix.


A convenience sample of 40 adults were recruited from five rural primary care clinics. The mean age was 62.13 (range 37-90) years. Analysis revealed that adult from rural communities self-reported higher levels of social support (instrumental (p


This study adds to the body of literature that is available on the perspectives, behaviors, and processes of self-management for rural adults with multiple chronic conditions. Next steps need to focus on the application of these results to the development of a tailored self-management intervention specifically for rural adults with multimorbidity.

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