Home » Self-Care Promotion » Guideline on how to promote self-care: Athlete’s foot » 3. Evaluate the mechanisms that hinder or facilitate the promotion of self-care

3. Evaluate the mechanisms that hinder or facilitate the promotion of self-care

Evaluate the mechanisms that might hinder or facilitate the promotion of self-care in your context (barriers and facilitators)

Evaluate the mechanisms that might hinder or facilitate the promotion of self-care
  • Evaluate the possible impact of hindering/facilitating mechanisms including:
    • Patients related factors
    • Professionals related factors
    • Environment related factors

One of the most important steps in promoting self-care is the identification and analysis of the mechanism that might hinder the promotion of self-care. Those can be present hindering the implementation of the self-care strategy, but also as facilitating the implementation.

When designing a self-care strategy one should identify and evaluate those mechanisms. To facilitate this step we propose a list of mechanisms that might affect the development of a self-care strategy. This list is not exhaustive but might be helpful to guide a systematic evaluation of hindering/facilitating mechanisms.

Note: When developing this step in a specific context, it could be very useful to involve all the relevant detected stakeholders to include their multiple perspectives, which can increase the chances of detecting the most relevant hindering/facilitating mechanisms and, ultimately, improve the chances of success of the promotion of self-care guideline.

  • Low health literacy: low levels of health literacy can make it harder forcitizens to engage in self-care behaviours. It has been reported that about 12% of the European population have inadequate general health literacy, and more than one third (35%) has problematic health literacy[4]. Health literacy can be one of the key determinants to address as it has been proven to be associated with health outcomes, health service use and quality of health systems as well as capacity building for professionals.
    Health literacy affects any strategy promoting self-care for any condition, including common athlete’s foot, and it can be one of the most relevant hindering mechanisms.
  • Poor information on prevention of athletes’ foot or condition (symptom recognition, possible treatment, usual evolution of symptoms…).The poor information can negatively affect self-care at any stage, for example: incorrect assessment of severity, delayed recognition of symptoms, biased expectations on the condition prognosis.
  • Poor information on the treatment options. The poor information on treatment options could lead to unnecessary consultation with the GP, or applying ineffective treatments.
    Particularly for athlete’s foot, patients should be more aware of the importance of completing the foot treatment and the associated self-care measures (dry the area well, etc.)
  • Lack of decision-making skills. The lack of decision making skills can be a hindering mechanism for the reduction of unnecessary visits to the GP.
  • Application of preventive measures. Reducing the contagion of athlete’s foot could be one of the benefits of the promotion of self-care. The poor skills of prevention can be one of the key hindering mechanisms particularly for the reduction of incidence.
  • Health beliefs of a particular group/individual at family, level, community level and overall cultural level.
  • Lack of commitment to completing the treatment.
Health status
  • Co-morbidities: co-morbidities might difficult self-care for minor conditions and, crucially, can be a very relevant risk factor. For athlete’s foot special caution should be paid for patients with diabetic foot (and patients with other types of neuropathies).
  • Impaired cognition can complicate self-care in multiple aspects, including the access to relevant information.
Demographic characteristics
  • Age: it seems that the group that tends to be more affected by athlete’s foot are teenagers and young adults.
  • Gender can have an impact on self-care in multiple aspects; particularly different conditions can have different effects on women and men. However it is not clear that it has a relevant impact regarding athlete’s foot for those specific issues.
Socio-economic status (and or minority groups)
  • Financial resources: lack of financial resources can complicate self-care by hindering the access to self-care medication (or self-care devices).
    The pricing systems and prescription discounts in many countries across Europe might deter patients/general population from directly consulting the community pharmacist and purchasing over-the-counter symptomatic treatments and might even incentivise using antibiotics in the most problematic cases.
  • Social exclusion: people in situation of social exclusion can have a more difficult access to self-care resources such as information sources, advice from professionals, etc.
  • Professional education to promote patient self-care can be key for a successful intervention. A good education on promotion of self-care or lack thereof can be critical as a positive driver or as an important complication.
  • Communication skills might not be a priority in the professional curricula. The lack or low confidence on the communications skills such it might difficult the promotion of self-care treatment options regarding athlete’s foot.
  • Healthcare professionals’ attitudes: the attitudes of healthcare professionals (including primary care, pharmacist, etc) is a critical factor for the implementation of a self-care strategy. It can difficult the development of a self-care strategy greatly or it can facilitate it considerably depending if they have a negative or positive attitude towards it.
Social factors
  • Social/cultural differences: might difficult understanding of self-care portals of information…
  • Low relevance of self-care promotion on health care education
Economic factors
  • Financial incentives for professionals: a key issue might be the cases of linking a part of the GPs salary to the number of consults. This can act as a barrier for GPs to actively encourage self-care.
  • Financial incentives for patients in some systems to seek prescribed self-care medication: In many health systems prescribed medication is discounted, compared to self-care medication purchased directly at the pharmacy. This fact might affect the decision of citizens to attend primary care doctors instead of attempting self-care.

As the review of potentially hindering or facilitating mechanisms reflect, there are three potentially key areas of hindering or facilitating mechanisms to consider:

  • Patient/general population knowledge and skills as key mechanisms for all the target issues
  • Professional behaviour, knowledge and skills can be key in the reduction of incidence, increase of adherence to treatment and reduced use of unnecessary antibiotics.
  • Specific population groups (young adults, co-morbidities) that should be acknowledged when promoting self-care in athlete’s foot.