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i
Promoting Self-Management
of Chronic Health Conditions
ii
iii
Promoting Self-Management
of Chronic Health Conditions
Theories and Practice
EDITED BY
ERIN MARTZ
1
iv
1
Oxford University Press is a department of the University of Oxford. It furthers
the University’s objective of excellence in research, scholarship, and education
by publishing worldwide. Oxford is a registered trade mark of Oxford University
Press in the UK and certain other countries.
9 8 7 6 5 4 3 2 1
Printed by Sheridan Books, Inc., United States of America
v
CONTENTS
vi Contents
Index 521
vi
Erin Martz has a PhD in Rehabilitation Education and Research and is a Certified
Rehabilitation Counselor. She has focused on research coping with and adapting
to chronic health conditions and disabilities for the past 20 years. She is a 2017
Fulbright Research Fellow for the U.S. Department of State, works as a research
investigator for the U.S. Department of Veterans Affairs, is an assistant professor
in the Department of Otolaryngology, Oregon Health and Science University, and
runs her own business called Rehability.
vi
ix
Promoting Self-Management
of Chronic Health Conditions
xvi
1
Introduction
Why Study Self-Management?
ERIN MARTZ ■
For decades, the World Health Organization (WHO; 1948) has defined health
as “a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity” (p. 1). This definition advanced the concept of
health in a more positive direction, away from the focus on eliminating diseases.
However, Huber and colleagues (2011) pointed out that the WHO’s definition
needs updating because of its high standard of a “state of complete physical, men-
tal and social well-being,” which may not be possible for many people who have
chronic health conditions. Huber and colleagues proposed a fundamental shift in
the definition of health, moving from the WHO’s idealistic definition to a more
flexible, practical, and responsive definition of health as being able to adapt and
self-manage in the context of chronic health conditions. This shift represents an
ideal of achieving “complete well-being” to a more reality-based acknowledge-
ment that many people have to deal with one or more chronic health conditions
in their lifetimes—and that chronic conditions do not necessarily signify poor
health or well-being.
The fundamental goal of the present book is to elaborate on both the theo-
ries and the practices that can help individuals with chronic health conditions
to become as independent as possible by self-managing their chronic health
2
conditions. Self-management has been defined in many ways (see chapter 2), but,
fundamentally, it involves individuals with health conditions taking responsibil-
ity for managing their symptoms to the extent that is possible, while collaborating
with healthcare professionals. The purpose of this book is to investigate the ways
that healthcare providers can promote self-management among individuals with
chronic health conditions.
The topics discussed in this book include reviews of theoretical models and
research on condition-specific, empirically based interventions that promote the
self-management of specific chronic health conditions among the adult popu-
lation. This introductory chapter briefly covers the purpose of this book, what
terms are (and are not) used in this book, and the structure of the book. But first,
this chapter begins with a discussion of why self-management is an important
topic in today’s healthcare environment.
There are three primary reasons why self-management should be a topic of scien-
tific research and consideration by healthcare providers and healthcare systems.
Introduction3
21.8% in 2001. They found higher prevalence rates of MCC among older adults.
Ward, Schiller, and Goodman (2014) analyzed the 2012 NHIS dataset and found
similar results: approximately half of the US non-institutionalized population
reported one of 10 chronic conditions, and 25.5% of them had MCC (i.e., two or
more chronic conditions). Because these analyses of the NHIS dataset included
only 10 conditions and did not include mental health conditions, Ward et al.
acknowledged that their calculations likely underestimated the true prevalence
of MCC.
The data cited in the previous two paragraphs highlight one reason why it is
important to focus on self-management: the occurrence of chronic health con-
ditions is increasing among the general population. Yet the increase of chronic
health conditions is not the only important indicator of the need to focus on
promoting self-management among chronic health conditions. The urgent need
to promote self-management arises from the danger of untreated or unmanaged
chronic health conditions. Seven of the 10 leading causes of death in the United
States are chronic health conditions (heart disease, cancer, chronic lower res-
piratory diseases, cerebrovascular diseases, Alzheimer’s disease, diabetes mel-
litus, and nephritis/nephrotic syndrome/nephrosis; National Center for Health
Statistics, 2015).
I T is not surprising that the first notable victim of the Terror was Matthew
Lyon whom we have seen insulted at various points when homeward
bound from Philadelphia. Bitter though he was, he had sound sense and
realized his danger. When the Rutland ‘Herald’ refused to publish his
address to his constituents, he launched his own paper, ‘The Scourge of
Aristocracy,’ with a defiant challenge: ‘When every aristocratic hireling
from the English Porcupine ... to the dirty hedge-hogs and groveling animals
of his race in this and neighboring States are vomiting forth columns of lies,
malicious abuse and deception, the Scourge will be devoted to politics.’
How Pickering must have stared through his spectacles at that defiance! But
patience! If speeches and papers offered no case, there still were letters, and
one was found. Here surely was ‘sedition.’ Had Lyon not referred to
Adams’s ‘continual grasp for power,’ to his ‘unbounded thirst for ridiculous
pomp, foolish adulation, and selfish avarice’? Had he not charged that the
President had turned men out of office for party reasons, and that ‘the sacred
name of religion’ was ‘employed as a state engine to make mankind hate and
persecute one another’? Had he not printed a letter from Barlow, the poet,
referring to ‘the bullying speech of your President and the stupid answer of
your Senate’? It was enough. True, the letter had been published before the
Sedition Law was passed, but this was the Reign of Terror. The trial before
Judge Peters was a farce, and the culprit was found guilty. ‘Matthew Lyon,’
said Peters in fixing the sentence, ‘as a member of the Federal Legislature
you must be well acquainted with the mischiefs which flow from the
unlicensed abuse of Government’—and Lyon was sentenced to four months
in jail and to pay a fine of a thousand dollars.
Then the Terror began to work in earnest. There was a fairly respectable
jail at Rutland where the trial was held, but not for Lyon. There was
something worse at Vergennes, forty miles away, a loathsome pen in a
miserable little town of sixty houses, and thither he was ordered. Refusing
his request to return to his house for some papers, he was ordered to mount a
horse, and with two troopers with pistols, riding behind, the forty-mile
journey through the wilderness was made. At Vergennes they pushed him
into a cell, sixteen by twelve, ordinarily used for common felons of the
lowest order. In one corner was a toilet emitting a sickening stench. A half-
moon door opened on the corridor, through which his coarse food was
passed. Through a window with heavy iron bars he got some light. There
was no stove and the cold of autumn nights came in through the window.
When it became dangerously chilly, the prisoner put on his overcoat and
paced the cell. He was refused pen and paper until the indignation of the
public forced a concession. A visitor peering through the half-moon of the
door a little later would have seen a table strewn with paper, Volney’s
‘Ruins,’ some Messages of the President.
Meanwhile the Vermont hills were aflame with fury. The Green Mountain
Boys, the Minute Men, the soldiers who, with Lyon, had followed Ethan
Allen, were talking of tearing the jail down. Then, from the filthy, foul-
smelling hole, into which the Federalists had thrown a member of Congress,
came letters from the ‘convict,’ brave, cheerful letters, exhorting these men
to observe the law. One day, however, Lyon was forced to plead through the
iron bars of his window for the furious mob without to seek redress legally at
the polls. Thus popular resentment increased with the growth of the
prisoner’s popularity. Thousands of the yeomanry of Vermont signed a
petition for a pardon and sent it to Adams, who refused to receive it. Aha,
‘the despicable, cringing, fawning puppy!’ exulted Fenno.[1528] The
indignation of the yeomanry of Vermont now blazed high. The
Administration was amazed, almost appalled. When this ‘convict’ in a
hideous cell was nominated for Congress, there were not jails enough in
Vermont for the talkers of ‘sedition.’ He was elected overwhelmingly with
4576 votes to 2444 for his nearest competitor.
Again the terrorists consulted on plans to thwart the public will. His term
was about to expire, but where would this pauper get a thousand dollars?
True, the farmers, the comrades of the Revolution, were going into their
pockets to get the money—but a thousand dollars! Still there was a chance.
The Marshal summoned Federalist lawyers to go over Lyon’s letters and find
more sedition on which he could be arrested on emerging from the jail. His
triumphant election was more than the terrorists could bear. ‘Must our
national councils be again disgraced by that vile beast?’ asked their New
York organ.[1529] Meanwhile, the problem of the fine was being solved. The
eyes of the Nation were on that dirty little cell at Vergennes. Jefferson,
Madison, Gallatin, John Taylor of Caroline, Senator Mason of Virginia—he
who had given the Jay Treaty to the ‘Aurora’—and Apollis Austen, a
wealthy Vermont Democrat, were solving the problem of the fine. On the
day of Lyon’s delivery, the Virginia Senator rode into the village, his saddle-
bags bulging with a thousand and more in gold. There he met Austen with a
strong-box containing more than a thousand in silver. Mason paid the
money.
Before the jail had assembled a vast multitude. Out of the door rushed
Lyon. ‘I am on my way to Philadelphia!’—to Congress, he shouted. A roar
went up, a procession with a flag in front was formed, and the ‘convict’ was
on his way triumphantly. The school children at Tinmouth paraded in his
honor, and a youthful orator greeted him with a welcome to ‘our brave
Representative who has been suffering for us under an unjust sentence, and
the tyranny of a detested understrapper of despotism.’ The woods
reverberated with shouts. Then on moved the procession. At Bennington,
another ovation, more speeches. Seated in a sleigh, his wife beside him,
Lyon was escorted by the throng. At times the procession was twelve miles
long. Through New York, New Jersey, Pennsylvania, the ovations were
repeated. He had gone home to the tune of ‘The Rogue’s March’; he returned
by the same route to the tune of ‘Yankee Doodle.’[1530]
II
The terrorists ground their teeth and sought revenge—with nothing too
petty. The Reverend John C. Ogden dared to be a Democrat and to carry the
petition for Lyon to Philadelphia. Thenceforth he was a marked man. He was
in debt—and a debt would serve. Returning from Philadelphia, he was
arrested at Litchfield, Connecticut, and thrown into jail. ‘It is presumed,’
sneered Major Russell of the Boston ‘Centinel,’ ‘that Lyon when he goes
from his jail to Congress will at least sneak into Litchfield to pay a visit to
his envoy and take a petition from him to the Vice-President
[Jefferson].’[1531] But jail was too good for such a rascal. On his release a
crowd of soldiers followed him out of Litchfield, calling him ‘a damn
Democrat,’ abusing, insulting, collaring, shaking him. It was their purpose to
take him back to Litchfield and scourge him in public. Whirling him around,
the gallant soldiers started back. Meanwhile, the report had spread that the
heroic remnant of the army had set forth on a mobbing expedition, and a
party of Democrats and civilians mounted horses and rushed to the rescue.
The courage of the soldiers, so splendid in the presence of one man, oozed
out on the approach of the rescuers, and Ogden was released.[1532]
III
But Ogden was not the only victim of the terrorists, among the friends of
Lyon. Anthony Haswell, born in England, a man of education, who had seen
service in the army of Washington and had narrowly escaped death at
Monmouth, was editor of the ‘Vermont Gazette.’ A gentleman of amiability
and integrity, his popularity was great in Vermont—but he was a
Jeffersonian. One day the sleuths of the Terror, scanning the pages of
Democratic papers, found an appeal in Haswell’s ‘Gazette’ for funds to pay
the fine of Lyon. It referred to the ‘loathsome prison,’ to the marshal as ‘a
hard-hearted savage, who has, to the disgrace of Federalism, been elevated
to a station where he can satiate his barbarity on the misery of his victims.’ It
was a faithful portrait. But in concluding, the article charged that the
Administration had declared worthy of the confidence of the Government
the Tories ‘who had shared in the desolation of our homes and the abuse of
our wives and daughters.’
Thus, one night there was a hammering on the door of Haswell’s house,
and he was confronted by petty officials and notified to prepare for a journey
to Rutland in the early morning. In feeble health, and unaccustomed to
riding, he was forced to mount a horse for the sixty-mile ride to the capital.
Through a cold October rain the sick man jolted along in misery through the
day, and it was near midnight when the town was reached. With his clothing
soaked, he begged permission to spend the night at a hotel where he could
dry it. This was curtly refused. At midnight they pushed the sick man in wet
clothing into a cell. Responsible men of Rutland begged permission to go
security to the end that the editor might spend the night in decent quarters—
it was denied. The next morning he was hurried to trial at Windsor before
Judge Paterson who, on the Bench, continued to be a New Jersey politician.
The defense introduced evidence to prove the charge of brutality against the
marshal, and asked the Court for permission to summon McHenry and
General Drake of Virginia to prove that on one occasion the Administration
had acknowledged the policy of occasionally appointing Tories to office.
The Court refused permission; and having refused, Paterson declared in the
charge that ‘no attempt had been made at justification’ of the reference to
Tories. The jury was probably packed. The verdict was promptly rendered—
guilty of sedition. And Haswell was sent to jail for two months. On the day
of the expiration of his sentence, a great throng assembled at the prison to
testify to their regard for Haswell and their contempt for the Sedition Law
and its sponsors. When the editor appeared at the door, the band played
while the crowd sang:
It was all too evident that, despite the Sedition Law, there were ‘Yankee
Doodles’ to ‘keep it up’ too numerous for the jails.
IV
Followed then the comedy. Among the desperate characters who had
assisted in the pole-raising at Dedham was Richard Fairbanks. A thoroughly
decent citizen, he was arrested and dragged tremblingly into court. Most of
the victims of the Sedition Law were unrepentant and defiant, but Fairbanks
was full of remorse. There may have been a bit of cunning in his confession
of past wickedness and his profession of conversion. At any rate, the scene
in court was not so threatening. True, the stern-faced Chase looked down
from the Bench, but there in the room, ready to plead for mercy, was Fisher
Ames. The charge was read, confessed, and up rose Ames. Not, however, as
a paid attorney did he appear, but there was something to be said in
extenuation for Fairbanks. He realized ‘how heinous an offense it was.’ He
had promised to be a good citizen in the future. ‘His character has not been
blemished in private life,’ the orator said, ‘and I do not know that he is less a
man of integrity and benevolence than others. He is a man of rather warm
and irritable temperament, too credulous, too sudden in his impressions.’ He
had been seduced by the ‘inflammatory sophistry’ of the illiterate Brown.
‘Besides,’ continued Ames, in his most virtuous tones, ‘men in office have
not been wanting to second Brown and to aggravate the bad opinion of the
government and the laws.... The men who had Mr. Fairbanks’ confidence
and abused it are more blameable than he. A newspaper has also chiefly
circulated there which has a pestilent influence.’ Thus he had bad advice.
‘Although Mr. Fairbanks was influenced like the rest and was criminal in the
affair of the sedition pole he had no concern in the contrivance. He ... has
freely confessed his fault and promised to be in future a good citizen.’
Having attacked the Jeffersonians in Congress and out, and denounced ‘The
Aurora’ or ‘Independent Chronicle,’ and implied that Fairbanks would vote
and talk right in the future, Ames sat down; and just as solemnly Chase,
commenting that ‘one object of punishment, reformation, has been
accomplished,’ fined him five dollars and sent him to jail for six hours.
Whereupon we may imagine Chase and Ames felicitating themselves on
having scared the Democratic and Jeffersonian devils out of one sinner.
This was comedy.
VI
VII
When Bache thus escaped the vengeance of his enemies, they turned to
his successor, William Duane, who soon proved himself a more vigorous
controversialist than his predecessor. A remarkable character was Duane,
entitled to a monument for his fight for the freedom of the press. Born in
America of Irish parentage, he was taken to Ireland on the death of his
father, and there he grew to manhood. His career previous to his return to
America was colorful and courageous. For a time he had been a reporter for
the London ‘Times’ in the press gallery of the House of Commons, before
establishing a newspaper in India which he edited with such signal ability
that the East India Company found it advisable to resort to force and fraud to
destroy his property and send him out of the country. At length in sheer
disgust he returned to America, and soon became the editor of ‘The
Aurora.’[1547]
One Friday night before the Monday on which the question of the repeal
of the Alien Law was to be considered in Congress, a number of citizens,
including some foreign-born, met in Philadelphia to arrange for a memorial
to Congress. On Sunday morning, Duane and three others, including Dr.
James Reynolds, appeared during services in the churchyard of Saint Mary’s
Catholic Church with the memorial and a few placards requesting natives of
Ireland in the congregation to remain in the yard after the services to sign the
petition. Some of these placards were placed on the church and on the gates
leading into the yard. Some belated worshipers of the Federalist persuasion
tore these down, and, entering the church, warned the priest that seditious
men were in the yard planning a riot. The four men in the yard conducted
themselves with perfect decorum. When the congregation was dismissed,
Duane and his party had the memorial spread upon a tombstone. A few
approached and signed. Almost immediately, however, the terrorists among
the members of the church closed in upon the group, centering their attacks
mostly upon Reynolds, who was knocked down and kicked. Struggling to
his feet, Reynolds drew a revolver and prepared to defend himself, at which
moment officers reached the scene and the four men were hurried off to jail
on the charge of creating a seditious riot.
Before a great crowd at the State House, the trial was held, with
Hopkinson, the author of the war song, as special prosecutor, and the men in
the dock brilliantly defended by A. J. Dallas. The testimony showed that
there had been no disturbance until the mob charged upon the men with the
memorial; that the memorial itself was unexceptionable in every way; that
Reynolds had been warned a week before of a conspiracy to murder him and
had armed himself on advice of a member of Congress; that none of the
others carried a weapon of any sort; and it was shown by the testimony of a
priest that it was then the custom in Ireland to post notices in churchyards,
and for members of the church to transact such public business in the yards
after services. Members of the congregation testified that they had wanted to
sign; the priest that the posting of the notice was not considered disrespectful
to the church. In a brilliant speech of sarcasm and invective, Dallas riddled
the prosecution, calling attention to attempts to intimidate lawyers from
appearing for the defense, charging the prosecution with being inspired by
partisan hate, and denouncing the Alien Law. Hopkinson replied lamely,
attacking immigrants and Democrats. The jury retired, and in thirty minutes
returned with a verdict of acquittal. The State House rang with cheers. The
case, however, had not been tried in a Federal Court.[1548]
That, however, was only the beginning of the attempt to wreck and ruin
the leading Jeffersonian editor. John Adams and Pickering had been
planning to reach him by hook or crook. The latter wrote Adams that Duane,
though born in America, had gone to Ireland before the Revolution; that in
India he ‘had been charged with some crime’; and that he had come to
America ‘to stir up sedition.’ More—he was ‘doubtless a United Irishman,’
and in case of a French invasion the military company he had formed would
join the invaders. The picture was as Adams would have had it painted. ‘The
matchless effrontery of Duane,’ he wrote, ‘merits the execution of the Alien
Law. I am very willing to try its strength on him.’ This trial was never made,
but two months later the Federal Courts began to move against him. At
Norristown, Pennsylvania, with Bushrod Washington and Richard Peters on
the Bench, an indictment was brought against him for sedition.[1549] The
case was continued until June, 1800—and Duane went full steam ahead with
his attacks on the Federalist Party. The trial was again postponed, and in
October, 1800, he was indicted again—this time for having published a
Senate Bill of a peculiarly vicious if not criminal character which its
sponsors for sufficient reasons wished kept from the public. But it was of no
avail. He would not cringe or crawl or compromise or be silenced. The cases
against him were dismissed when Jefferson became President. Many
historians have belittled him; he fought brilliantly for fundamental
constitutional rights when men high in office, who are praised, were
conspiring to strike them down.
VIII
One day the Sedition snoopers fell upon an article by Dr. Thomas Cooper,
an Englishman by birth, a scientist and physician by profession, a man of
learning and culture, and a Jeffersonian. It referred to the early days of
Adams’s Administration when ‘he was hardly in the infancy of political
mistake.’ It charged Adams with saddling the people with a permanent navy;
with having borrowed money at eight per cent; referred to his ‘unnecessary
violence of official expression which might justly have provoked war’; to his
interference with the processes of a Federal Court in the case of Robbins.
And that was all. Adams had made mistakes, had established a permanent
navy, had borrowed money at eight per cent; and many thought at the time
that he had unduly interposed in the Robbins case. But this was sedition in
1800.
Hustled into the Federal Court at Philadelphia, Cooper found the red-
faced Chase glowering upon him from the Bench—the same Chase who had
been charged by Hamilton with speculating in flour during the Revolution.
There was no denial of the authorship of the article. The evidence in, Chase
charged the jury in his most violent partisan manner. There are only two
ways to destroy a republic, he said: one the introduction of luxury, the other
the licentiousness of the press. ‘The latter is more slow but more sure.’
Taking up the Cooper article, he analyzed it in the spirit of a prosecutor.
Here, thundered the Judge, we have the opinion that Adams has good
intentions but doubtful capacity. Borrowed money ‘at eight per cent in time
of peace?’ What—call these times of peace? ‘I cannot suppress my feeling at
this gross attack upon the President. Can this be true? Can you believe it?
Are we now in time of peace? Is there no war?’[1550] The jury promptly
returned a verdict of guilty. The next day Cooper appeared for sentence.
Asked by Chase to explain his financial condition as that might affect the
sentence, he replied that he was in moderate circumstances, dependent on his
practice, which would be destroyed by imprisonment. ‘Be it so,’ he
continued. ‘I have been accustomed to make sacrifices to opinion, and I can
make this. As to circumstances in extenuation, not being conscious that I
have set down aught in malice, I have nothing to extenuate.’ Chase became
suspiciously unctuous and oily. If Cooper had to pay his own fine, that
would be one thing; if his party had arranged to pay the fine, that would be
another. ‘The insinuations of the Court are ill founded,’ Cooper replied with
indignation, ‘and if you, sir, from misapprehension or misrepresentation,
have been tempted to make them, your mistake should be corrected.’ Judge
Peters, who had been squirming through these amazing partisan comments
of Chase, here impatiently intervened with the comment that the Court had
nothing to do with parties. Whereupon Cooper was fined a thousand dollars
and ordered to jail for six months.[1551]
Duane instantly announced an early publication in pamphlet form of the
trial in full. ‘Republicans may rest completely assured,’ he wrote, ‘that they
will have every reason to be satisfied with the effect of this most singular
trial on the mind of the public.’[1552] The pamphlet appeared, and, as Duane
had foreseen, the public was aroused. A man of decent character and high
professional standing was languishing in a jail in the capital of the country
for having told the truth and expressed an opinion on a constitutional
question. There were rumblings and grumblings in the streets, and some
uneasiness in Administration circles. The hint went forth that an appeal for a
pardon might receive consideration, and one was put in circulation, when out
from the ‘convict’s’ cell came a letter of protest. He wanted and would have
no petition for pardon. He believed with Adams that repentance should
precede pardon[1553] and he had no feeling of repentance. ‘Nor will I be the
voluntary cat’s-paw of electioneering clemency,’ Cooper continued. ‘I know
that late events have greatly changed the outward and visible signs of the
politics of the party, and good temper and moderation is the order of the day
with the Federalists now, as it has always been with their political opponents.
But all sudden conversions are suspicious, and I hope that Republicans will
be upon their guard against the insidious or interested designs of those who
may wish to profit by the too common credulity of honest intention.’[1554]
The petition was dropped. Cooper remained happily in his cell. His
incarceration was making votes for Jefferson. When, on the expiration of his
sentence, Cooper stepped into the daylight, he found a deputation of his
friends awaiting him at the door. He was escorted to a fashionable hotel
where a public dinner had been arranged to honor him and express contempt
for the Sedition Law. Two long tables were set, with Dr. James Logan
presiding over one, Thomas Leiper over the other. That night, as the wine
flowed, the men who would not be silenced drank to Cooper—to Jefferson—
to a Democratic victory.[1555]
IX
XI
XII