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

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.