Home » Self-Care Promotion » Guideline on how to promote self-care: Heartburn (without indigestion) » 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. 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.
    Health literacy affects any strategy promoting self-care for any condition, including heartburn (without indigestion), and it can be one of the most relevant hindering mechanisms.
  • Poor information on the treatment options. Poor information on treatment options could lead to delay the visit to the GP.
  • Poor information on navigation of the healthcare system. Poor information on the healthcare system can lead to underuse consultation with professionals, as patients/general population might not be aware of other possible consultations with professionals that might be available, such as pharmacist.
  • Lack of decision-making skills can be a hindering mechanism to consider not necessary a visit to the GP and establish a drug treatment and appropriate dose, avoiding misuse of antacids.
  • Application of preventive measures. Following general recommendations on healthy lifestyle general and specifically aimed at preventing heartburn. The poor skills of prevention can be one of the key hindering mechanisms particularly for the reduction of incidence.
Attitudes and beliefs
  • Contrary to popular culture milk is not indicated for heartburn. A glass of milk can relieve heartburn, although only temporarily because its content in calcium, protein and fat in particular stimulate stomach to produce more acid.
Health status
  • The objectives of this study were to assess health state utilities in patients with gastroesophageal reflux disease with heartburn and to analyze if severity and annual frequency of heartburn can predict utilities. A total of 1011 patients in Germany and Sweden participated in telephone interviews, where utilities were assessed using the rating scale (RS), EQ-5D, time trade-off (TTO) and standard gamble (SG) instruments. The average RS, EQ-5D, TTO, and SG utilities were 0.69, 0.70, 0.88, and 0.89, respectively. Linear regression analyses showed that the EQ-5D and RS utilities were negatively and significantly related to the severity and frequency of heartburn. The EQ-5D and RS results indicate that patients with heartburn assign their health states substantial disutility and that it is feasible to estimate regression equations to predict utilities from heartburn-specific variables. In the TTO and SG analyses, the impact of heartburn was in the expected direction but smaller and in general not significant.
  • However inadequate and prolonged use of antacids, can cause serious digestive problems and even gastritis.
Demographic characteristics
  • Age: Extreme ages (infants and elderly) are more vulnerable to the presence of pictures of dysphasia due to immaturity in infants and changes in esophageal motility in the elderly, who also refer attenuated symptoms and not for the importance of the lesion, thus favouring the occurrence of unexpected complications. In these cases it is useful for primary care and routine visits of patients over 60 years, a special interest or a proactive approach to periodically review the onset of symptoms that on normal circumstances would not be cause for consultation.
  • Gender: Literature describes a certain predominance in men but evidence is not conclusive.
  • Pregnant women: It is part of the usual cohort of symptoms that accompany pregnancy but is a self-limiting symptom in the vast majority of women.
Socio-economic status (and or minority groups)
  • Economic: payment for visit to GP can prevent some people to attend even when thy needed. It does not probably affect countries where access to healthcare is universal (e.g. Spain).
  • Lack of communication skills to devote to education in healthy lifestyles.
  • Lack of communication skills and time to educate patients on:
    • Help patients identify triggers of heartburn and/or GERD presented, so this will help you and give adequate advice to minimize them.
    • Explain them content of treatment and chance of taking alternative treatment or intermittent on-demand.
    • Explain them why only treatment with antacids is not sufficient and why self-medication with substances such as bicarbonate of soda is not advised.
    • Report them that obesity, smoking and certain medications can worsen symptoms.
Organizational factors
  • Availability (or not) of educational information to disseminate healthy lifestyle or adequate treatment or linguistic educational level to population.
  • High average of visits to physician does not allow spending time explaining self-care.
Economic factors
  • Countries where access to healthcare is not universal or there is copayment for prescriptions.