4. Select and implement self-care promotion interventions
Select and implement self-care promotion interventions
4.1. Linking intervention(s) with the hindering/facilitating mechanisms
Once the hindering or facilitating mechanisms have been identified a key next step can be to link interventions to those mechanisms.
There are numerous interventions that could potentially contribute to the promotion of self-care in athlete’s foot for the selected target issues (reduce incidence; reduce severity of cases; reduce unnecessary visits to GPs and reduce inadequate use of antibiotics).
The table presented in point 4.2 highlights types of interventions that could target those issues addressing the detected hindering or facilitating mechanisms, with special attention three key areas of hindering or facilitating mechanisms highlighted before: the patients’/general population knowledge and skills, organizational factors and the specific most vulnerable groups in the general population.
4.2. Selecting intervention (s)
As it was highlighted in the subjective evaluation of mechanisms there are three key areas of 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.
The following tables illustrate types of self-care promotion interventions that could address those mechanisms with the final goal of improving the key issues highlighted.
It is important to bear in mind that most interventions are multifaceted so include more than one area, however to facilitate the analytical line the interventions have been divided in information strategies and organizational strategies.
- Information, with a special focus on symptom recognition and evaluation.
One of the identified potentially hindering mechanisms was the lack of knowledge regarding what to expect when someone has athlete’s foot, to be aware of treatment options and recommendations for symptom relieve. Information strategies can have some beneficial results to tackle this issue. Some examples of those initiatives are:
Examples of similar practices in:
- UK: NHS Choices – Athlete’s foot 
- France: Améli.Santé – Pied d’athlète 
- Netherlands: Zelfzorg.nl – Voetschimmel 
- Sweden: 1177- Fotsvamp 
- Know who to turn to: as one of the hindering mechanisms identified is the poor knowledge of navigation health systems, it might be of interest to review information strategies specifically addressed to cover this issue, that usually also entail evaluation of symptoms and treatment decision making.
This style of information campaign has been applied in multiple primary care trusts across the UK. For some examples see:
NHS Scotland: Know who to turn to  or NHS Grampian: Know who to turn to .
Both cases exemplify a combination of those two complementary information strategies would help to address two of them most relevant aspects: symptom recognition and information on navigation of health system.
Note: An information campaign should be tailored to the needs of its target population, so depending on the ethnic composition of the implementing context, the material of the interventions might have to be translated to multiple languages and be adapted to some cultural traits (see implementing intervention sub-section)
Note: One important consideration would be the different mechanisms to be used for such information campaigns, to that regard see WP2 – Communication tools.
For the highlighted most vulnerable groups
- Children under 3 – partnership with nurseries to educate both educators and parents in the recognition of symptoms.
- Delayed prescriptions: in some cases the prescription is for self-care for a given period of time. If in this period of time the symptoms do not improve significantly the patient can get the prescribed antibiotic without returning to the GP consultation (important: the antibiotic is only available after a given number of days from the prescription and not before).
This strategy can help reduce the use of antibiotics as in many cases the symptoms will subside after some days of proper self-care.
In addition the prescription of self-care encourages a conversation about the importance and effectiveness of self-care in minor conditions.
- Minor ailments schemes, partnerships between GPs and community pharmacists
These types of program are based on directing people with minor ailments to the community pharmacist as the first health professional (instead of directly consulting to the GP). This approach has been tested and adapted in the UK in several NHS areas, with some different characteristics. However, most programs included two key aspects:
- Including the treatments that the pharmacist might suggest in the prescription system for (people marinating the free-of-charge or discounts)
- Establishing a fast-track for GP consultation if the pharmacist decides to refer.
Those schemes have reported promising results.
For some examples see:
- Greater Manchester Minor Ailments Scheme – Pharmacy First 
- NHS Scotland – NHS minor ailment services 
Remember that before implementing a piloting of the interventions is recommended. For tips regarding Implementation of interventions see the section in the general guideline.