Self care interventions to advance health and wellbeing: a conceptual framework to inform normative guidance

Narasimhan, Manjulaa; Allotey, Pascale; Hardon, Anita

doi:10.1136/bmj.l688

Cited by 106 publications

(134 citation statements)

References 16 publications

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“…We encourage meaningful involvement of individuals or groups representing target populations in the design and cocreation of research methodologies to optimise benefits to individuals and the wider group while minimising burdens to the participants. This approach is supported by ethical considerations29 and several frameworks that promote person-centred interventions 30 31…”

Section: Discussionmentioning

confidence: 99%

Prioritising gender, equity, and human rights in a GRADE-based framework to inform future research on self care for sexual and reproductive health and rights

Siegfried¹,

Narasimhan

Logie

et al. 2020

BMJ Glob Health

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IntroductionIn January 2019, the WHO reviewed evidence to develop global recommendations on self-care interventions for sexual and reproductive health and rights (SRHR). Identification of research gaps is part of the WHO guidelines development process, but reliable methods to do so are currently lacking with gender, equity and human rights (GER) infrequently prioritised.MethodsWe expanded a prior framework based on Grading of Evidence, Assessment, Development and Evaluation (GRADE) to include GER. The revised framework is applied systematically during the formulation of research questions and comprises: (1) assessment of the GRADE strength and quality rating of recommendations; (2) mandatory inclusion of research questions identified from a global stakeholder survey; and (3) selection of the GER standards and principles most relevant to the question through discussion and consensus. For each question, we articulated: (1) the most appropriate and robust study design; (2) an alternative pragmatic design if the ideal design was not feasible; and (3) the methodological challenges facing researchers through identifying potential biases.ResultsWe identified 39 research questions, 7 overarching research approaches and 13 discrete feasible study designs. Availability and accessibility were most frequently identified as the GER standards and principles to consider when planning studies, followed by privacy and confidentiality. Selection and detection bias were the primary methodological challenges across mixed methods, quantitative and qualitative studies. A lack of generalisability potentially limits the use of study results with non-participation in research potentially highest in more vulnerable populations.ConclusionA framework based on GRADE that includes stakeholders’ values and identification of core GER standards and principles provides a practical, systematic approach to identifying research questions from a WHO guideline. Clear guidance for future studies will contribute to an anticipated ‘living guidelines’ approach within WHO. Foregrounding GER as a separate component of the framework is innovative but further elaboration to operationalise appropriate indicators for SRHR self-care interventions is required.

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Section: Discussionmentioning

confidence: 99%

Prioritising gender, equity, and human rights in a GRADE-based framework to inform future research on self care for sexual and reproductive health and rights

Siegfried¹,

Narasimhan

Logie

et al. 2020

BMJ Glob Health

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“…The Ayurvedic and traditional concept of wellness has an important role to play in the broadening perspectives of global health and public health and appropriate methodological frameworks need to be created to study the relevance and evidence base of the holistic approach of Svasthya being ‘rooted within’ ( 57 ). This concept also needs to be systematically researched in the context of its importance in self-care ( 56 ) and in primary care in health systems. And finally, the salutogenesis concepts of Ayurveda(32) and the balance between health, stress and coping, which is important and potentially very useful in the current public health approach to COVID-19 investigation.…”

Section: To Use the Covid 19 Pandemic As An Opportunity To Develop Hementioning

confidence: 99%

‘Population self-reliance in health’ and COVID-19: The need for a 4th tier in the health system

Mathpati¹,

Payyappallimana²,

Shankar³

et al. 2022

Journal of Ayurveda and Integrative Medicine

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The COVID-19 pandemic is straining health systems globally. The current international biomedical focus for disease control and policies fails to include the resource of a population’s capacity to be self-reliant in its health care practices. The ancient wisdom of Ayurveda (‘the knowledge of life’) and Local Health Traditions (LHTs) in India understand that health is about Svasthya , ‘being rooted within’; a concept that includes the relationship and balance between the individual, their families, communities and the environment in creating their own health. This ‘population self-reliance in health’ is the focus of the 4 th Tier in the health system which honours and respects an individual’s capacity for self-care and their inherent responsibility to the health system and its values. It encourages the inclusion of this knowledge in the creation of health systems and in the policies that direct them. Research and practice into the 4 th Tier will provide health systems and policy information into how communities are managing the COVID-19 epidemic. These insights will help into the creation of future health systems that are better aligned to the ‘self-reliance in health’ of individuals and their communities.

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“…Applying digital technologies to SRH self care may increase SRH information and resources access [8]. For instance, for self-care interventions such as HIV self-testing [9], digital technologies could facilitate further support via mobile phones, instructional videos, or SMS.…”

Section: Introductionmentioning

confidence: 99%

“…For instance, for self-care interventions such as HIV self-testing [9], digital technologies could facilitate further support via mobile phones, instructional videos, or SMS. Thus, the use of digital technologies for SRH self care could improve correct use of interventions, and empower individuals to better manage their health [8]. Mobile apps for SRH may be used by lay persons for particular functions (e.g.…”

Section: Introductionmentioning

confidence: 99%

Sexual and reproductive health mobile apps: results from a cross-sectional values and preferences survey to inform World Health Organization normative guidance on self-care interventions

Logie

Okumu

Abela

et al. 2020

Global Health Action

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Mobile application (app) platforms have the potential to advance sexual and reproductive health (SRH). Yet there is a dearth of knowledge regarding global perspectives from healthcare providers on how SRH mobile apps are being leveraged in their healthcare practice. In 2019 the World Health Organization (WHO) developed a consolidated guideline on self-care interventions for SRH. To inform this guideline, we conducted a global values and preferences survey. This study aimed to (a) understand the awareness, access, and uptake of SRH mobile apps; (b) examine how many healthcare provider (HCP) participants provided linkages, referrals and information to clients regarding SRH mobile apps; and (c) among HCP, assess how many felt confident and informed regarding SRH mobile apps. We hosted a crosssectional web-based survey on the WHO Department of Reproductive Health and Research website and shared the survey with SRHR listservs. There were 825 survey participants, 360 whom identified as healthcare providers (HCP). Approximately one-third of HCP participants had provided a referral/information to their clients about sexual or reproductive health apps. While 40.8% of HCP felt confident and informed about sexual health apps, half (47.4%) reported needing more information, and 15.6% expressed interest in receiving training to use in practice. While 42.6% of HCPs felt confident and informed about reproductive health apps, 45.7% needed more information, and 15.1% were interested in further training. There was also an open-ended question for HCP to share their thoughts about self-care SRH interventions. Specifically regarding SRH apps, HCP responses revealed the importance of considering: (a) security and confidentiality; (b) potential benefits of SRH apps for underserved groups (i.e. youth, rural communities); (c) community engagement; (d) health benefits; and (e) and online training for HCP on SRH mobile apps. Findings signal interest and opportunities for training and engaging HCP in using mobile apps to advance SRH.

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Self care interventions to advance health and wellbeing: a conceptual framework to inform normative guidance

Abstract: Manjulaa Narasimhan and colleagues argue that there is a pressing need for a clearer conceptualisation of self care to support health policy

Cited by 106 publications

References 16 publications

Prioritising gender, equity, and human rights in a GRADE-based framework to inform future research on self care for sexual and reproductive health and rights

Prioritising gender, equity, and human rights in a GRADE-based framework to inform future research on self care for sexual and reproductive health and rights

‘Population self-reliance in health’ and COVID-19: The need for a 4th tier in the health system

Sexual and reproductive health mobile apps: results from a cross-sectional values and preferences survey to inform World Health Organization normative guidance on self-care interventions

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