Changing the conversation about health
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Background: What’s happening in self care

man taking exercise in a gymWhat is self-care?

Self-care is the care taken by individuals towards their own health and well being, including the care extended to their children, family, friends and others in neighbourhoods and local communities. It includes the actions people take for themselves, their children and their families to stay fit and maintain good physical and mental health; meet social and psychological needs; prevent illness or accidents; care for minor ailments and long-term conditions; and maintain health and wellbeing after an acute illness or discharge from hospital. Department of Health[1]

 Language and values

The language of self-care is not the same as that of the medical world. The values are different too. Professional direction and evidence-based standards do not always cut much ice here. A recent systematic review of almost 50 UK studies[2] indicated that decisions about self-care are determined particularly by anecdote and opinion, personal recommendation or previous experience by a friend or family member.

A review of engagement with self-management guidance[3] found information was only taken up if it is both perceived to be useful and is presented in meaningful ways. Failure to appreciate the complexity of living with a long-term condition was seen as a notable weakness in many patient information campaigns.

So, what choices do we make when caring for ourselves? According to the Proprietary Association of Great Britain (PAGB) 90% of common illnesses are already treated without bothering the health professionals. In 2007, we bought over 976 million packs of over-the counter (OTC) medicines, compared with 873 million prescriptions. There are more savings that could be made by supporting informed self-care: the PAGB calculates that 52 million prescriptions a year are for minor ailments that people could probably treat themselves. That costs the NHS £370 million.

Over the counter

People caring for themselves choose from a broad range of products. The over-the-counter market includes both pharmaceutical and complementary treatments (notably herbal remedies): 49% of women and 28% of men have used these and would use them again. This demand is reflected by growth in this area consistently stronger than in the sector as a whole. A further 27% of adults who have not yet used complementary health products would consider them. This points to a new role for professional engagement with self-care. When patients ask about non-orthodox options, they deserve to be given informed and non-judgmental advice.

Clearly there are huge potential benefits in supporting and encouraging informed self-care where possible. But there is a different agenda when people are caring for themselves rather than consulting a health professional. A major review by the Department of Health found that self-care initiatives are most productive and sustainable where they promote informal or formal groups and social interactions rather than relying solely on delivering information.

vegetablesEngagement

Rather than information campaigns, it is engagement with the message, and with each other, that is crucial. The professional role needs to shift away from telling us what we should do and move towards guiding us in our choices and facilitating us when we act on those choices.

Our new Self-Care Faculty will address these needs by working with a broad range of stakeholders in a co-operative endeavour: charities and social enterprises, patient groups and health professional partnerships. Building on a significant Department of Health project, it will help to develop an integrated programme for facilitating self-care, in collaboration with the British Holistic Medical Association and others. This will include:

A user-friendly online guide to a wide range of self-care options, allowing people to create personalised self-care plans. It will be written in everyday language, with clear ratings of likely benefit, risk and cost. The content is being reviewed by users as well as academic experts and practitioners.

A trial programme with the Department of Health, providing Health Facilitators in GP practices. These are people who can integrate health care services and local community engagement with self-care, and provide individual or group guidance;

New design concepts and pilot initiatives to bring the waiting room to life, helping to make the average 20 minutes waiting for consultations more constructive.

Mechanisms to enable more convenient and effective social prescriptions by GPs and other health professionals.

The Faculty is working closely with the Patients’ Council and Educational Committee to co-ordinate our services and offer help to all those looking after themselves and their families.

References:

1 – Department of Health.  Health ‘Self care – A real choice: Self-care support – A practical option.’  January 2005

2 – Ryan A, Wilson S, Taylor A, Greenfield S.  ‘Factors associated with self-care activities among adults in the United Kingdom: a systematic review.’   BMC Public Health.  2009;9.96.

3 – Protheroe J, Rogers A, Kennedy AP, Macdonald W, Lee W.  ‘Promoting patient engagement with self-management support information: qualitative meta-synthesis of processes influencing uptake.’   Implement Sci. 2008; 3:44