3. Evaluate the mechanisms that might hinder or facilitate the promotion of self-care
Evaluate the mechanisms that might hinder or facilitate the promotion of self-care
One of the most important steps in promoting self-care is the identification and analysis of the mechanism that might hinder or facilitate 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 and adapt the implementation strategy accordingly. Often those mechanisms can inform the selection of the self-care intervention for your strategy. For example: if you are targeting a population with low health literacy the communication strategies should be designed based on easily understandable content.
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.
There are different types of techniques to identify these mechanisms that should be selected depending on the type of minor conditions, the objective of the strategy and the available resources (such as focus groups, interviews,etc.).
List of key hindering/facilitating mechanisms
- 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 inadequate 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 (symptom recognition, possible treatment, usual evolution of symptoms…).The poor information can negatively affect self-care at any stage, for example: incorrect assessment of seriousness, delayed recognition of symptoms, biased expectations on the condition prognosis.
- Poor information on the treatment options. The poor information on treatment options could lead to unnecessary consultation with the GP, or applying incorrect treatments (for example non EB -evidence based- lay remedies).
- Poor information on navigation of the healthcare system. Poor information on the healthcare system can lead to unnecessary consultation with professionals.
- Lack of decision-making skills.
- People’s tendency to delegate their health to professionals (low patient activation).
- Health beliefs of a particular group/individual at family, level, community level and overall cultural level.
- Lack of confidence on one’s abilities to have an impact on one own health (low self-efficacy).
- Tendency to repeat behaviour. In most cases a consultation with a GP, even for self-limiting minor conditions leads to a prescription of treatment. This practice can affect potential changes towards self-care due to the tendency to repeat behaviours. For example, a study developed in the UK found that within the sample of people who had received a prescription from a general practitioner the last time they had a minor ailment, 62% visited a GP again when faced with a similar minor ailment. This tendency to repeat behaviour can also be presented as a facilitating mechanism, for example the same UK study reported that 84% of people that had past experience with self-care choose self-care for new episodes of minor ailment.
- Patients/general population self-care health value, which might influence patients/general population self-care coping strategies. In long-term self-care strategies it has been recommended that attention is paid to the patient’s self-care coping strategy, and that self-care protocols should be tailored to complement the different types of self-care health values that patients might have.
- Co-morbidities: co-morbidities might make difficult self-care for minor conditions more complex and, crucially, can be a very relevant risk factor.
- Impaired cognition can complicate self-care in multiple aspects, including the access to relevant information.
- Demographic characteristics
- Gender can have an impact on self-care in multiple aspects; particularly different conditions can have different effects on women and men. For example lower urinary tract infection is on the one hand much more common among women and on the other it can be much more risky for men.
- 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.
- 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.
- 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.
- Healthcare professionals’ attitudes: the attitudes of healthcare professionals towards the importance of the patients’ self-care (including primary care, pharmacist, etc.) are 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.
On the other hand easy access can act as a facilitator. For example according to the survey of Chain of Trust Project, approximately 98% of EU citizens can reach their nearest community pharmacy within 30 minutes, while 58% of citizens indicate that their closest community pharmacy is within 5 minutes reach from their work or home . Take advantatge of the community pharmacists could be a facilitator to promote the self-care in minor conditions.
- 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 OTC: In many health systems prescribed medication is discounted, compared to OTC purchased directly at the pharmacy. This fact might affect the decision of citizens to attend primary care doctors instead of attempting self-care.
(We are developing an interactive table to categorise the mechanisms and working on presenting the bibliographical references in a clear way)