The therapeutic mechanism-trajectories principle (TMTP): A framework for informational architecture in chronic disease self-management.

Abstract

Self-management interventions in chronic disease are frequently communicated as general wellness advice. Horne's Necessity-Concerns Framework showed adherence tracks perceived necessity (OR = 1.742) and ameliorated concerns (OR = 0.504); Miller found health literacy correlates more strongly with adherence for non-medication regimens (r = 0.20) than medication regimens (r = 0.09). Neither addresses the authority signals prescriptions carry and self-management advice lacks. Discussion paper grounded in conceptual analysis, integrating Horne's NCF, Miller's health literacy work, Leventhal's CSM, and Witte's EPPM. Choroideremia serves as the illustrative case, and the author has lived with CHM since age 15. The Therapeutic Mechanism-Trajectories Principle (TMTP) specifies what disease-specific information clinician-patient communication should include, rather than how the conversation should be conducted. Mechanism grounds an intervention's necessity in its disease-specific biomolecular basis, including dosing and risk profile; what must transfer is that a mechanism exists and is this patient's. Trajectories communicates the outcomes varying adherence produces over time, conceived through the Geodesic Concept as a curve from the patient's present position, shaped by adherence and routing around barriers. TMTP specifies what content is owed; how much and in what form is clinician judgment stated with its basis and uncertainty. Applied to choroideremia, it reframes UV-blocking sunglasses, antioxidant supplementation, and omega-3/DHA through their biomolecular basis. Reference literature must supply mechanism, trajectory, and dosing content, including a plain statement where dosing evidence does not exist, as a precondition to effective clinician-patient communication. TMTP applies wherever a disease-specific mechanism can be communicated, with the greatest gain where self-management is the only option; implementation cost is unknown and requires study. Reference literature should integrate the biomolecular basis and dosing guidance into self-management recommendations. Clinicians should communicate that basis at a calibrated level, present the outcomes different adherence levels produce, and surface barriers to adherence.