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 Heartburn (without indigestion).
Some of the key drivers could be:
- The high prevalence of heartburn (without indigestion)
This is a very common gastrointestinal symptom. It is estimated that 40% of adults experience heartburn at least once a month, and half of those affected, once a week, although it is difficult to know exactly true prevalence of heartburn in general population, as not all individuals who has it requested medical attention .
An approximate prevalence of 10–20% has been identified for GERD (defined by at least weekly heartburn and/or acid regurgitation), in the Western world .
There are no significant differences in prevalence of heartburn by sex, although clinical studies agree that males experienced it most intensely. It is not a symptom that is often occurred in childhood, although it can occur in young people. Disproportionately it affects people over 55 years.
The incidence of heartburn in the population is generally very high, observing even with an increase in recent decades. In Western countries it affects daily 3-10% of the population or in other words approximately 1 out of 10 adults at least once a week. Prevalence increases also with age. 
- Impact on the life of those affected
Study Psychological Well Being Index shows 73% of patients report symptoms interfere quite in their daily activity and 4.8% only occasionally.
Psychological stress and psychiatric disorders (anxiety, depression, chronic stress, … ) have been associated with symptoms of GERD (Gastroesophageal Reflux Disease) and functional dyspepsia.
- Reduce self-medication (inappropriate use of antacids)
The heartburn is one of the most common complaints in GP representing around 8.2% of the population examined. However, only 50 % of patients go to see a doctor when this symptom occurs. As this is not associated with any particular disease, usually they do not go to see a doctor and innappropiated self-medication with antacids could be observed.
- Reduce the completion of initial diagnostic from initial symptoms (reducing severity or early diagnosis)
Elderly patients, institutionalized or with social integration problems have more difficulty or trivialization of identifying initial symptoms and diagnosis before first symptoms (dysphasia, odynophagia, HDA, recent clinic onset in patients older than 45 years, significant weight loss, etc.).
1.2. Identify whether those issues are related to a specific minor conditions or a general approach to self-care
Heartburn (without indigestion) is one of the usual minor conditions in terms of number of people affected. The key issues that drive the promotion of self-care are mostly common to other minor conditions.
Regarding the other highlighted issues (high incidence, severity of cases, automedication..) 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.
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)
- Industry, self-care medication and medical devices industry
- Patient organisations and other NGOs
- Healthcare managers
- Policy decision makers
- 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 Heartburn (without indigestion) the following resources could be particularly useful if available:
- Is there a plan to encourage the proper use of antacids?
- Is there already good and systematic exchange of information between community pharmacies and primary care healthcenters 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.