‘Self-care’ and its relevance to developing demand management strategies: a review of qualitative research

Abstract

The promotion of self-care has been recognized as an important aspect of managing demand for health care more effectively. Self-care is increasingly being seen by policy makers as a hidden health care resource to be viewed in the context of health care provided by the formal health care sector. Quantitative studies are important for understanding the effectiveness of interventions in terms of the impact they may have on health service utilization. However, questions remain about the reasons people may or may not adopt self-care, the mechanisms for change and the way in which social context may affect the way in which people respond to self-care interventions. Qualitative research that has focused on people's self-care practices provide insights into these aspects. The qualitative studies reviewed here suggest that a number of factors need to be considered when devising health care interventions for managing demand better. These include an assessment of the meaning of the disease to the person so that self-care information can be designed in a way that fits people's prior beliefs and lifestyles. Timing and the stage in a person's illness career are also important factors to consider when designing effective self-care interventions. Social interaction and the impact of significant others may affect whether or not a self-care regime is followed, and autonomy and control are also relevant to designing acceptable self-care strategies. Incorporating these aspects of self-care as a dynamic and interactive process is important for both devising and assessing the impact of interventions aimed at the better management of demand.

The Birmingham Rehabilitation Uptake Maximisation Study (BRUM). Home-based compared with hospital-based cardiac rehabilitation in a multi-ethnic population: cost-effectiveness and patient adherence

“…This links in with work describing how patients with chronic illness develop and continually adapt their own strategies for self-care which suit their social, psychological and physical situation at the time. 168,169 Patients are often reluctant to discuss self-care strategies with healthcare professionals 170 and our study highlights the importance of exploring patients' informal health behaviours.…”

Nurses’ responses to expert patients: The rhetoric and reality of self-management in long-term conditions: A grounded theory study

“…Whilst these activities can be seen to form the basis of self-care and self-management, there are a number of ways that they can be enacted. Chapple and Rogers (1999) put forward four types of selfcare behaviour: regulatory, preventative, reactive, and restorative, with Toljamo and Hentinen (2001) describing four differing modes of self-care: flexible, regimen adherent, self-planned or neglect. Not all these modes are professionally set, and professional approval is unlikely to be gained by neglect, or even in some cases self-planned self-care.…”

Giving instruction on self-care during midwifery consultations in Japan

“…Self-care has been discussed as a key element of contemporary medicine due to its recent focus on patient's autonomy, and it is defined as a patient's active involvement for the purpose of care (Chapple and Rogers, 1999;Makinen et al, 2000;Paterson et al, 2001;Piette et al, 2003;Siguroardottir, 2004;Soller, 1998;Steward et al, 2004). Under the goal of enhancing a patient's autonomy in medical practice, a medical professional faces the task of correctly estimating a patient's competency and knowledge during discussion of self-care.…”