Home » Self-Care Promotion » Guideline on how to promote self-care: Cold » 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 those stakeholders that have been identified 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 for patients/persons to engage in self-behaviours (for more general information see the general guide).
    Particularly relevant to self-care of common cold it should be noted that low health literacy can be particularly problematic with over-the-counter medications.
    A 2010 US study found that caregivers treating infants with over the counter medications had problems following the indications, even when those parents had a mean education level of 12.5 years[7].
    More specifically the authors found that when examining the front of the product label, 86% of the time caregivers thought the products were appropriate for use in children <2 years of age. More than 50% of the time, parents stated they would give these over-the-counter products to a 13-month-old child with cold symptoms. Common factors that influenced parental decisions included label saying “infant,” graphics (eg, infants, teddy bears, droppers), and dosing directions.
    Even further the study found that caregivers were influenced by the dosing directions only 47% of the time[7].
    In addition, caregivers with lower numeracy skills were more likely to provide inappropriate reasons for giving an over-the-counter medication [7].
  • Poor information on condition (symptom recognition, possible treatment, usual evolution of symptoms…). Can negatively affect self-care at any stage, particularly for the prevention stage.
    Regarding cold the recognition of symptoms and the information about the normal evolution of the condition can be two areas the hinder the reduction of unnecessary visits to GPs and the inappropiate us of antibiotics.
    More specifically, a 2015 US study found that misperceptions regarding etiology and treatment of the common cold were prevalent. And pointed out that the main limitation is potential recall bias, since people with cold had to recall cough/cold episodes over the prior year to decide their self-care treatment [6].
  • Poor information on the treatment options. This could lead to unnecessary consultation with the GP, or applying ineffective treatments (for example not-proven lay remedies) or unnecessary antibiotics.
    A 2015 systematic review found a general lack of knowledge about antibiotics. More specifically the systematic review found that 53.9% of people did not know that antibiotics are not useful against viruses. In addition 26.9% of the people did not know that misuse of antibiotics can lead to antibiotic resistance. Finally, 47.1% of the people declared that they stop taking antibiotics when they start feeling better [8]
  • Poor information on navigation of the healthcare system. Poor information on the healthcare system can lead to unnecessary consultation with professionals, as patients/general population might not be aware of other possible consultations with professionals that might be available (community pharmacists, health-information phone-lines, etc.).
  • Lack of decision-making skills. can be a hindering mechanisms for the reduction of unnecessary visits to the GP and crucial, the reduction of inappropiate use of antibiotics.
  • Application of preventive measures. Reducing the contagion of cold could be one of the key 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.
Attitudes and beliefs
  • Beliefs about cold
    A 2000 US study [9] found that of the adults seeking care for a child or themselves:

    • 44% believed viruses alone cause the common cold; an additional 42% believed both viruses and bacteria play a role.
    • Most thought rest (97%) and nonprescription medications (63%) were helpful for colds, which was consistent with published reports.
    • Contrary to medical reports, however, most felt vitamin C (67%) and the inhalation of steam (70%) reduced cold symptoms, and 44% believed antibiotics help colds (c2=19.57; P=.0002).
    • But 85% believed colds could resolve on their own.
  • Believes about the effectiveness of antibiotics
    A 2000 US study on the characteristics of adults and caregivers of children with cold who want antibiotics found that those who ask for antibiotic are more likely to believe that antibiotics helps with cold symptoms, despite the abundant evidence. Similarly adults who want antibiotics were more likely to belive that they had previously recovered faster with antibiotic therapy and to be confident that they knew how to treat cold. In addition they were less likely to believe that too many people take antibiotics for cold [9][10].
Health status
  • Health related quality of life
    The authors of a 2015 study in Japan found association between Health related quality of life and self-care. They found that people who engage in self-care when treating the common cold had significantly higher levels of Health realted quality of life than among individuals who preferred to attend a health clinic.
    It should be noteed that the authors couldn’t discern whether self-care behavior affects quality of life, or whether quality of life affects self-care behavio. Even with this limitation the results of the study highlight the importance of the relationship between quality of life and self-care behavior. [11]
  • Co-morbidities: co-morbidities might inhibit self-care for minor conditions and, crucially, can be a very relevant risk factor. Co-morbidities are key factor to drive people to consult with their GP. In these cases consultation shouldn’t be discouraged. However efficient systems of consultation (telephone, webcam) can be explored.
  • In these cases consultation shouldn’t be discouraged.
  • Impaired cognition can complicate self-care in multiple aspects, including the access to relevant information.
Demographic characteristics
  • Age: regarding cold the effect of age is most clear on children under 3 or eldery people who might be more vulnerable to complications such as ear infections or pneumonia among others. Although more serious complications such as pneumonia are relatively rare, the risk of those specific age groups should be considered and can hinder the promotion of self-care.
    It has to be considered that self-care should only be promoted if the expected benefits no not imply serious risk (or if it outbalances minor risks).
  • 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 cold 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), affecting the decision to take a sick-leave (maybe incurring on loss of (part of) the salary for some days), etc.
    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.
  • Prescription of antibiotics for self-limiting minor conditions. This behaviour might incentivise patients/general public to visit GPs whenever they have a minor condition. The prescription of antibiotics can reinforce a patient to repeat the consultation with the GP in future episodes of common cold.
  • 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 inhibit the promotion of self-care treatment options regarding cold.
  • 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
Organizational factors
  • Issuance of work leave (sick certificate): in many countries the work leave is covered by Social Security schemes/insurance schemes if this is linked to a medical certificate it directs people with a minor condition to directly consult with GPs, even for cases that could be self-treated (for example cold).
  • Access to resources: the variation in accessibility of key resources (for example web portals) to self-care can act as a barrier.
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
  • Organizational and economic factors to tackle a possible reduction of unnecessary visits to GPs and the reduction of inappropiate use of antibiotics (which also highly depends of professionals’ clinical practice).
  • Specific population groups (age and co-morbidities) that should be acknowledged when promoting self-care in cold.