Naturalistic Decision-Making Patterns in Cardiometabolic Multimorbidity Self-Care: A Qualitative Study.

Authors

Jianing Yu, Haoyang Du, Manjun Wang, Junqiang Zhao, Yufeng Zhou, Erxu Xue, Lijin Chen, Hui Zhang, Jing Shao

Published in

Annals of family medicine. Volume 24. Issue 4. Pages 311-320. Jul 27, 2026. Epub Jul 27, 2026.

Abstract

Self-care is central to managing cardiometabolic multimorbidity, yet primary care clinicians have limited insight into how patients navigate self-care decisions in daily life. This study explored self-care decision-making contexts, processes, and patterns among patients with cardiometabolic multimorbidity to inform family medicine practice.
We conducted a qualitative cohort study guided by naturalistic decision-making theory among 27 adults with cardiometabolic multimorbidity (mean age = 62.7 years; 16 men). Participants were purposively sampled from a tertiary hospital and a community health center in Zhejiang Province, China. We conducted semistructured, face-to-face interviews with patients between September 2024 and February 2025. Transcripts were analyzed using an integrated thematic and narrative approach within a context-mechanism-outcome framework.
Self-care decision making among the patients occurred within problem-driven contexts of uncertainty, characterized by 4 dominant "problem" themes: persistent symptom-management challenges, acute health crises, psychological and emotional distress, and uncertainty in illness and treatment. Across 134 self-care decision-making chains, 4 patterns were identified: an experience-anchored pattern (drawing on past experiences for quick responses), a values trade-off pattern (balancing health against competing life priorities), a passive-reactive pattern (making decisions reactively only when compelled by acute crises or authoritative warnings), and a proactive-integrative pattern (leveraging multiple resources proactively to address potential health issues).
Patients with cardiometabolic multimorbidity navigate self-care through 4 decision-making patterns. Recognizing these patterns may help family physicians tailor communication, clarify patients' values, promote shared goal setting, and strengthen patient self-efficacy by linking patients to community and psychosocial resources, thereby supporting continuity, timely help seeking, and person-centered care for cardiometabolic multimorbidity.

PMID:
42509162
Bibliographic data and abstract were imported from PubMed on 28 Jul 2026.

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