1. Identify the problem and evaluate your context
Identify the problem and evaluate your context
1.1. Define what specific issue(s) you are trying to address
The first step when deciding to launch a self-care (or any other) initiative is to clarify what is moving you to launch this initiative. Specifically, to identify what are the drivers that are moving forward this need for change.
The key drivers depend on each specific context, however a review of the literature point towards some of most common drivers relating to athlete’s foot.
Some of the key drivers could be:
- Reduce the incidence among the general population
Tinea pedis are common worldwide and their incidence continues to increase, being one of top 10 dermatosis types in Dermatology practices. The vast majority of population in developed countries has had or will have an episode of tinea pedis, often subclinical infection.
Nearly 15% of population suffers from fungal foot (tinea pedis or athlete’s foot). Although tinea pedis may occur as several forms, toes web (interdigital) and plants, heels and sides of foot (plantar or moccasin distribution) are the most common. Once infection has been contracted it can spread to other places such as fingernails, which can be a source of reinfection.
This infection spread worldwide but mostly in urban environments. It predominantly affects young adult males who wear occlusive footwear, although it can be seen in both sexes and at any age. It is more common during spring and summer months. The principal causative agent is Trichophyton rubrum, which tends to be chronic and often subclinical infection.
- Increase the adherence to treatment
In general, compliance among patients suffering from dermatomycosis, especially in the feet and nails, is very low and unsatisfactory. Patients do not carry out properly the treatment; they reduce number of daily doses to apply of antifungal ointment and also drop out of treatment prematurely.
Many topical antifungal medications do not help to easy comply the treatment. Ointmet should be applied regularly throughout the day, and for long periods of time, even after the symptoms of fungal infection have disappeared.
The fact that some patients do not consider important fungal infection of the foot due to ignorance of its possible complications also contributes to this situation.
This is worrying not only by increasing recurrences involved, but also the risk of creating strains resistant to various antifungal.
It is therefore essential to ensure patient compliance through a proper healthcare professional-patient communication and the use of antifungal medication that minimize this risk, either because they require less daily applications but also a shorter duration of treatment.
- Reduce unnecessary visits to GPs.
The high incidence of athlete’s foot makes it one of the most numerous reasons for consultations to the GP. In general terms a study for the UK found that 39% of GP time is spent dealing with patients suffering from self-treatable minor ailments.
Most cases of athlete’s foot are mild and can be treated with an antifungal medication. In most cases in a first visit the GP will prescribe an antifungal medication.
If someone affected with athlete’s foot waits to go to the GP after self-treating with antifungal medication for the recommended period (if symptoms do not start getting better within the 7-10 days), it could reduce the number of visits to GPs and the visit in itself would be more significant. At that point proper diagnosis might need tests administered by healthcare professionals.
- Reduce inadequate use of antibiotics.
It is well known that antibiotics are used in circumstances where they are not necessary. One of the circumstances when antibiotic is unnecessarily used is to treat athlete’s foot, antibiotic should be only used with professional prescription in specific circumstances (for example if there is a bacterial superinfection, oral or topical antibiotics should be added to the treatment).
Those drivers for change are just suggestions and need to be adapted to each context. It could be that when planning a self-care in your context you find that you want to tackle the low adherence to treatment and the inadequate use of antibiotics, but in your context the number of visits to the GP is not an issue, or is not an issue that you can tackle at this point in time.
1.2. Identify whether those issues are related to a specific minor conditions or a general approach to self-care
Athlete’s foot is a very common minor condition in terms of number of people affected. Therefore the key issues that drive the promotion of self-care are mostly common to other minor conditions.
Particularly, reducing the inadequate use of antibiotics is an issue that should be addressed across all the health system if a strategy should be effective.
Regarding the other highlighted issues (high incidence, low adherence to treatment, unnecessary visits to the GP) those can also be shared with other minor conditions and the strategies used to tackle those issues can also encompass other minor conditions, albeit with specific elements that should be adapted to each specific condition.
Although there is no data comparing by minor conditions it might be that treatment adherence is particularly low in the case of athlete’s foot. Probably this can be related to the long periods of treatment and a relatively low perception of risk of complications.
1.3. Identify stakeholders and resources available for the self-care strategy
- Stakeholders involved for the self-care strategy: A key determinant of a successful intervention can be the inclusion of the relevant stakeholders. Anyone who wants to promote self-care should identify the stakeholders that are/could be involved and what is expected of each of them. Identifying those stakeholders at an early stage can facilitate a better coordination and a better use of all the available resources. Stakeholders should be defined in each specific context.
The following, but not limited to, key groups of stakeholders should be considered:
- Healthcare and social care professionals (and professional bodies)
- Patient organisations and other NGOs
- Healthcare managers
- Policy decision makers
- Industry, self-care medication and medical devices industry
- Workplace related stakeholders
The table included in the general guideline exemplifies some of the different key stakeholders at local, regional and country level.
1.4. Identify the self-care support resources available in your context
If you want to successfully promote self-care in your context, a key step can be to identify the existing resources.
Regarding the key issues that have been highlighted regarding athlete’s foot the following resources could be particularly useful if available:
- Is there a plan to encourage the proper use of antibiotics in place?
- Is there already good and systematic exchange of information between community pharmacies and primary care health canters and hospitals?
- Are health information portals already active in your context? Are they well known and used?
The following table illustrates a possible way to summarize the basic characteristics of an evaluation of the context for the self-care strategy.If possible, completing this review with all stakeholders might prove useful.
Note that depending on your position (policy decision maker; healthcare professional, member of patient organisation…) you might have different possibilities and ability to involve other stakeholders.