Home » Self-Care Promotion » Guideline on how to promote self-care: Cough » 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)

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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 these 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 these 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.

Patients
Knowledge
  • Low health literacy:
    The poor information can negatively affect self-care at any stage.
    Low levels of health literacy can make it harder for patients/persons to engage in self-care behaviours. It has been reported that about 12% of the European population have inappropriate general health literacy, and more than one third (35%) has problematic health literacy. 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.
  • Poor information on condition:
    Cough is a symptom of other conditions, not a condition in itself, as such it might difficult identifying relevant information for lay persons.
    People with acute cough, not related to chronic conditions, often do not have reliable information that cough is a self-limited process. This might incentives unnecessary self-medication.
Skills
  • Lack of decision-making skills can be a hindering mechanism for the reduction of unnecessary visits to the GP and crucially for the reduction of inappropriate use of antibiotics.
  • Application of preventive measures. Reducing the contagion of underlying causes of cough (such as 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
  • Some population groups believe that the best treatment in the presence of cough is taking antibiotics. In most cases of acute cough, antibiotics are unnecessary [4] because its most frequent cause are viral infection. The use of antibiotics without medical prescription involves health risks and could contribute to the promotion of resistant bacteria.
Health status
  • Patients with respiratory or cardiac comorbidity can lead to confuse self-limited and acute cough with secondary cough to chronic process.
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.
  • 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.
Professionals
Behaviours
  • Unnecessary prescriptions of antibiotics for self-limiting minor conditions. This behaviour might incentives 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.
Knowledge
  • 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.
Skills
  • 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 cough prevention and control measures.
Attitudes
  • The attitudes of healthcare professionals (including primary care, pharmacist, etc) are a critical factor for the implementation of a self-care strategy. They need to be aware about the importance of educating patients and carers about how to prevent and reduce the impact of cough.
Environment
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.