Abstract
Diaries have been used in health care practice for many years, particularly for patients with chronic diseases whose condition may be prone to subtle deterioration. Initially the diaries were seen as a means of communication between the patient and the health care practitioner, but in recent years, with the emphasis on patient self-management, diaries are being seen as a way in which patients can take responsibility for their own health and self-monitor their own condition. In this study, the researchers, concerned by the fact that many patients do not continue to use their diaries (despite the documented advantages), decided to investigate the factors influencing diary use in a group of patients who had been given a diary to use after an educational programme to foster self-care behaviours.
This is a small study and the researchers themselves recognise its limitations, but their findings do provide some guidance for a larger, more robust study as well as for practitioners who recommend diary use to patients. Key to this study was the diary itself and so I was disappointed that no description had been given of the diary. For example, was it a structured diary with boxes where patients could fill in their daily physical measurements and tick-box their symptoms, or was it an open text diary where patients could write what they wanted, or even something in between? Similarly, none of the questions in the evaluation questionnaire seemed to be about the layout of the diary. Layout and design are important features of a diary and different people like different styles. For those people who claimed not to continue using the diary because they did not have enough time, a quick tick-box might have been more suitable. For those who feel constrained by this style, a more open structure could be more suitable. Health professionals often bemoan the fact that patients do not do what the evidence suggests is best practice, but if attention is paid to the best way this practice can be incorporated into the lifestyles of individuals, there is a greater chance of the guidance being followed.
Patients’ perceptions of the purpose of the diary seemed to affect how long they continued to use it. Those people who perceived the diary as an aid to themselves, to help them manage their own health, were more likely to continue to use it, whereas those who seemed to think it was a medium of communication with their doctors and nurses became disappointed when no one looked at it. They then discontinued using the diary because no one else looked at it.
The message from this study, for those who want patients to use diaries, is to emphasise and re-emphasise that the diary is an aid to self-management and then individualise the diaries so that they suit the needs of the patient. A message to researchers could be to evaluate different types and styles of diary.