Chronic illness: the process of integration

J Clin Nurs. 2008 Apr;17(7B):177-87. doi: 10.1111/j.1365-2702.2007.02244.x.


Aim: The aim of this study was to explore how adults with a chronic illness integrate the illness experience into their life context.

Background: Adults with chronic illnesses are challenged to learn self-management strategies to prevent complications and achieve an acceptable quality of life. Integration represents the process undertaken by an individual to achieve a sense of balance in self-managing a chronic illness and living a personally meaningful life.

Design: A mixed-method descriptive design was employed to recruit English-speaking adults with a chronic illness. A semi-structured interview was completed, transcribed verbatim and content analysed. Descriptive data were collected on demographics, co-morbidity and depressive symptoms. The research was undertaken in Connecticut, USA.

Results: The sample (n = 26) was diverse with respect to age (25-80 years), education (8-24 years), duration of illness (1-39 years), gender (63% female) and ethnicity (63% white). Participants reported a mean of four chronic illnesses and 31% of the sample had increased depressive symptoms. The process of integration was complex and multifactorial. Themes of integration included: shifting sands, staying afloat, weathering the storms, rescuing oneself and navigating life. Numerous factors including treatment side effects, a progressive or uncertain illness trajectory, co-morbidity, bad days, financial hardships and interpersonal/environmental challenges contributed to a disruption or difficulty in the integration process.

Conclusion: All participants made considerable effort to integrate the illness into their life context and participate in a personally meaningful life. However, it was easy to be consumed with 'living an illness' as the daily tasks, the changing symptoms and the fluctuating emotions could be overwhelming. There was a complex co-existence between 'living a life' and 'living an illness'.

Relevance to clinical practice: There were numerous challenges to the process of integration and ongoing self-management, psychosocial, vocational and existential support appears indicated, particularly with individuals with multiple chronic illnesses, progressive chronic illnesses and limited resources.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living / psychology
  • Adaptation, Psychological*
  • Adult
  • Aged
  • Aged, 80 and over
  • Attitude to Health*
  • Chronic Disease / prevention & control
  • Chronic Disease / psychology*
  • Connecticut
  • Cost of Illness
  • Female
  • Health Services Needs and Demand
  • Humans
  • Interprofessional Relations
  • Life Change Events
  • Male
  • Middle Aged
  • Nursing Methodology Research
  • Qualitative Research
  • Quality of Life / psychology
  • Self Care / methods
  • Self Care / psychology*
  • Self Concept*
  • Sick Role
  • Social Support
  • Surveys and Questionnaires