Middle-Range Theory of Self-Care of Chronic Illness: 2025 Update Explained
SEO Title: Middle-Range Theory of Self-Care of Chronic Illness – 2025 Update Explained
Search Description: A clear summary of the 2025 update to the Middle-Range Theory of Self-Care of Chronic Illness, covering self-care maintenance, monitoring, management, symptoms and the six requirements for effective self-care.
The article An Update to the Middle-Range Theory of Self-Care of Chronic Illness by Barbara Riegel, Tiny Jaarsma and Anna Strömberg is an important update to one of the most widely used nursing theories for understanding how people live with and manage chronic illness. The original Middle-Range Theory of Self-Care of Chronic Illness was published in 2012, updated in 2019 to integrate symptoms more clearly, and has now been revised again to reflect new evidence, clinical experience and theoretical development.
This summary explains the key ideas in simple language, focusing on what the theory means for patients, carers, nurses, healthcare professionals, researchers and anyone interested in chronic illness self-care, self-management and long-term health.
What is the Middle-Range Theory of Self-Care of Chronic Illness?
The Middle-Range Theory of Self-Care of Chronic Illness describes self-care as a behavioural process used by people with chronic illness to maintain health, monitor changes and respond when symptoms occur. It is called a “middle-range” theory because it is more focused and practical than a broad grand theory, but still general enough to apply across many chronic conditions such as heart failure, diabetes, COPD, cancer, kidney disease and multiple long-term conditions.
The theory is built around three core concepts:
- Self-care maintenance
- Self-care monitoring
- Self-care management
Together, these concepts describe how people look after themselves day to day, how they notice changes in their bodies, and how they respond when problems arise.
1. Self-care maintenance
Self-care maintenance refers to the everyday behaviours people use to preserve health, improve wellbeing, prevent deterioration and maintain physical and emotional stability. These behaviours may include taking medication as prescribed, eating well, being physically active, attending appointments, reducing health risks, getting enough sleep, managing stress and following treatment plans.
In chronic illness, maintenance behaviours are not optional extras. They are central to living as well as possible with a long-term condition. For example, a person with heart failure may need to take diuretics, monitor fluid intake and follow dietary advice. A person with diabetes may need to manage food choices, medication, glucose monitoring and physical activity. A person with COPD may need inhaler technique, smoking cessation support, pacing and vaccination.
The updated theory makes clear that self-care maintenance is not only about preventing illness from getting worse. It also includes maintaining emotional balance and wellbeing. This matters because chronic illness affects more than the body. It can influence confidence, independence, identity, mood, social life and quality of life.
2. Self-care monitoring
Self-care monitoring is the process of observing oneself for changes. The updated article describes this as routine vigilant surveillance, self-awareness, body monitoring and body listening. In practical terms, it means paying attention to signs and symptoms before they become serious.
Monitoring may involve checking blood pressure, weight, blood glucose, breathlessness, swelling, pain, fatigue, mood, appetite, sleep, medication side effects or any symptom that is relevant to the person’s condition.
This part of the theory is especially important because many chronic illnesses fluctuate. A person may have good days and bad days. Symptoms may appear gradually. Some changes may feel minor at first but later become clinically important. Self-care monitoring helps people notice patterns and recognise when something is different from their usual baseline.
The 2019 update to the theory strengthened the role of symptoms, and the 2025 update continues that direction. Symptoms are not simply events that happen to patients; they are signals that require detection, interpretation and sometimes action.
3. Self-care management
Self-care management refers to the response to signs and symptoms when they occur. This may mean taking action at home, adjusting behaviour, using an agreed action plan, contacting a healthcare professional, seeking urgent help or making decisions based on previous experience.
For example, a patient with asthma may increase reliever inhaler use and follow an asthma action plan when symptoms worsen. A patient with heart failure may respond to sudden weight gain or ankle swelling by following professional advice. A person with diabetes may treat hypoglycaemia quickly after recognising symptoms.
The theory highlights that management depends on more than simply knowing what to do. People need confidence, skills, motivation, reflection and support. A person may have information but still struggle to act if they feel overwhelmed, depressed, unsupported, financially constrained or unsure whether symptoms are serious.
The major 2025 update: six requirements for effective self-care
One of the most important additions in the updated article is a detailed discussion of six essential intrapersonal requirements for effective self-care. These are:
- Experience
- Knowledge
- Skills
- Reflection
- Decision-making
- Motivation
These six factors help explain why self-care can be easy for one person and very difficult for another. They also help healthcare professionals design better interventions. Education alone is often not enough. Patients may need practical skill-building, confidence, problem-solving support, emotional support and opportunities to reflect on what works for them.
Experience
Self-care is learned over time. People become better at recognising their symptoms, understanding their bodies and knowing what actions help through repeated experience. Someone newly diagnosed with a chronic illness may not yet know what is normal for them, whereas someone who has lived with a condition for years may have developed strong personal expertise.
Knowledge
Knowledge matters because people need to understand their condition, medication, warning signs and treatment plan. However, the theory does not treat knowledge as sufficient by itself. A patient may know what to do but still face barriers to doing it.
Skills
Skills are practical abilities. These may include using an inhaler correctly, checking blood glucose, recording symptoms, managing medication, using medical equipment, communicating with healthcare professionals or following an action plan. Good self-care often depends on being able to perform these tasks reliably.
Reflection
Reflection is a key part of the updated theory. It means thinking about one’s own self-care, noticing what works, learning from mistakes and adjusting behaviour. The article highlights that self-care can be reflective or automatic, but ideally patients are reflective in how they perform self-care.
Decision-making
Chronic illness often requires everyday decisions. Is this symptom serious? Should I rest or be active? Should I call the clinic? Should I take action now or monitor for longer? Decision-making is therefore central to self-care management.
Motivation
Motivation affects whether a person begins and continues self-care behaviours. Chronic illness can be exhausting, and motivation may be influenced by mood, beliefs, fatigue, social support, culture, previous experiences, health literacy and the person’s relationship with healthcare services.
Why symptoms are central to the updated theory
The updated theory gives symptoms a central role. This is important because symptoms are often the point where self-care maintenance, monitoring and management connect. A person may maintain health through daily behaviours, monitor for symptoms, detect a change, interpret what it means and then decide how to respond.
The process is not always simple. Symptoms can be vague, confusing, frightening or easy to dismiss. Some people may under-recognise symptoms, while others may become highly anxious about bodily sensations. The theory helps clinicians and researchers think more carefully about symptom detection, interpretation and response rather than assuming patients automatically know what to do.
Why this update matters for healthcare practice
The 2025 update matters because it gives healthcare professionals a clearer framework for supporting self-care. Instead of simply telling patients what to do, clinicians can assess which part of self-care is difficult.
For example:
- If the problem is knowledge, the patient may need clearer education.
- If the problem is skills, the patient may need demonstration, practice and feedback.
- If the problem is monitoring, the patient may need help recognising signs and symptoms.
- If the problem is decision-making, the patient may need an action plan.
- If the problem is motivation, the patient may need emotional support, goal-setting or shared decision-making.
- If the problem is reflection, the patient may benefit from reviewing what happened after symptoms or treatment changes.
This makes the theory useful for nursing care plans, chronic disease reviews, patient education, rehabilitation, community care, digital health tools and self-management interventions.
Why this update matters for research
For researchers, the updated theory gives a stronger basis for designing and evaluating self-care interventions. It encourages researchers to look beyond whether a patient follows advice and to ask why self-care succeeds or fails.
The theory can guide research questions such as:
- Which interventions improve self-care maintenance?
- How do patients learn to monitor symptoms accurately?
- What improves decision-making during symptom worsening?
- How do motivation and self-efficacy influence self-care?
- What role do carers and family members play in self-care?
- How can digital health tools support reflection and symptom monitoring?
The update also suggests that self-care theory is relevant beyond chronic illness alone. The authors note that the concepts may also be useful in prevention, rehabilitation, acute illness, intermittent illness and severe stress.
Key takeaway
The central message of the updated Middle-Range Theory of Self-Care of Chronic Illness is that self-care is an active, learned and dynamic process. It involves maintaining health, monitoring the body, recognising and interpreting symptoms, making decisions and responding appropriately.
The 2025 update strengthens the theory by adding six important requirements for effective self-care: experience, knowledge, skills, reflection, decision-making and motivation. These additions make the theory more useful for real-world clinical practice, patient education, nursing research and chronic illness support.
For patients, the theory recognises that self-care is not always easy. For healthcare professionals, it provides a practical way to identify barriers and offer more personalised support. For researchers, it gives a stronger framework for designing interventions that help people live better with chronic illness.
References
- Riegel B, Jaarsma T, Strömberg A. An Update to the Middle-Range Theory of Self-Care of Chronic Illness. Advances in Nursing Science. 2025. DOI: 10.1097/ANS.0000000000000594. PubMed record.
- Riegel B, Jaarsma T, Strömberg A. A Middle-Range Theory of Self-Care of Chronic Illness. Advances in Nursing Science. 2012;35(3):194–204. DOI: 10.1097/ANS.0b013e318261b1ba.
- Riegel B, Jaarsma T, Lee CS, Strömberg A. Integrating Symptoms Into the Middle-Range Theory of Self-Care of Chronic Illness. Advances in Nursing Science. 2019;42(3):206–215. DOI: 10.1097/ANS.0000000000000237.
- Lawless MT, Tieu M, Feo R, Kitson AL. Theories of self-care and self-management of long-term conditions by community-dwelling older adults: a systematic review and meta-ethnography. Social Science & Medicine. 2021;287:114393. DOI: 10.1016/j.socscimed.2021.114393.
- Lee CS, Westland H, Faulkner KM, et al. The effectiveness of self-care interventions in chronic illness: a meta-analysis of randomized controlled trials. International Journal of Nursing Studies. 2022;134:104322. DOI: 10.1016/j.ijnurstu.2022.104322.