Fostering reliance on our health system for the maintenance of everyone’s wellbeing is a fool’s errand. Our health systems simply could not cope if people did nothing to look after themselves.
The empowerment of people to take responsibility and action for their health is critical for their own wellbeing and that of our society. This principle forms the basis of the concept of ‘self-management’, which is frequently used in the context of disease1. There are multiple benefits to individuals and society from chronic disease self management2, but the term itself (often appended to diseases; e.g. diabetes self-management, self-management of cardiovascular disease), exposes a disease-focused approach to healthcare that is outdated3.
What is self-care?
The concept of ‘self-care’ is more focused on wellbeing than illness. The World Health Organisation defines self-care as, “The ability of individuals, families and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a health-care provider.” Self-care practises nurture awareness, balance, flexibility, physical health, social support, and spirituality4.
Among health professionals, self-care has received particular attention for its ability to help avoid burnout in mental health practitioners8. In this context, the focus is the prevention or minimisation of specific adverse outcomes, but the goals of self-care may be less definite. Self-care includes the activities people undertake that help them to feel good. Reading books with their children, a quiet dinner with their partner, getting a massage and meditation are examples of activities that can be good for health and wellbeing but are not necessarily part of managing chronic illness or disease, or avoidance of specific health problems. The same self-care behaviour practised by different people may be less definite.
Self-care includes the activities people undertake that help them to feel good. Reading books with their children, a quiet dinner with their partner, getting a massage and meditation are examples of activities that can be good for health and wellbeing but are not necessarily part of managing chronic illness or disease, or avoidance of specific health problems. The same self-care behaviour practised by different people may be motivated by different goals. For example, participation in sport might be motivated by someone’s value of the social contact it provides, rather than the benefits of physical activity.
By understanding what your patients do for self-care, and why they do it, you may be better able to tailor their healthcare needs and advise others. It’s possible that some of your patients’ self-care practises are things that you haven’t thought about5.
The impact of self-care
Self-care has become popularised as part of the global wellness market, which is worth $4.5 trillion US (5.3% of global economic activity) with annual growth of over 10%6. More than $1 billion of this is on personal care, beauty and anti-aging products. However, half of this market is spending on things that likely interact with contemporary health care — physical activity, diet and nutrition, weight loss, preventive and personalised medicine, and traditional and complementary medicine.
It’s at the intersection of self-care and healthcare where individuals’ self-care behaviour can impact the treatment provided by healthcare professionals. For example, interactions between nutritional supplements or over the counter medicines with prescribed medications can impact treatment efficacy. An awareness, by health professionals, of what patients do to look after themselves is needed to inform appropriate care7.
Talking to patients about self-care
There’s not a lot of evidence to guide health professionals when it comes to discussing self-care with patients. A survey of 1006 adults and 304 primary-care physicians8, conducted in the United States in 2019, found:
- Most doctors and patients agree that conversations about self-care are important, but these discussions were not as common as either group would like
- Critical aspects of self-care, including life goals, social and emotional needs, the use of complementary medicine, and spiritual or religious needs, were discussed by 12% or fewer of the patients and their doctors
- Two-thirds of patients want their doctors to provide more self-care resources, have greater involvement in all aspects of their health management, and to incorporate complementary therapies.
The future of self-care?
The potential benefits to individuals and our healthcare system of patients’ self-care activities are laid out in Self-Care for Health: A National
Policy Blueprint9. The blueprint, launched by Federal Health Minister Greg Hunt in October 2020, includes nine priority policy proposals that aim to align self-care and healthcare:
- Improving health literacy for all
- Building self-care into healthcare practice
- Enabling consumers to be active partners in health care
- Assuring quality and accessibility of digital health information
- Measuring and evaluating self-care
- Funding models to support self-care services
- Invest in preventive health and self-care
- Establish a national approach
- Support health through all public policies.
The growing awareness and practise of self-care offers the promise to health care professionals of more informed, engaged and active patients. For the patients, it offers the prospect of relying less on the healthcare system.
1 Gobeil-Lavoie et al., 2019. Characteristics of self-management among patients with complex health needs: a thematic analysis review. BMJ Open
2 Lorig et al., 2001. Chronic Disease Self-Management Program: 2-Year Health Status and Health Care Utilization Outcomes. Medical Care.
3 Bandura, 2004. Health Promotion by Social Cognitive Means. Health Education & Behavior
4 Posluns & Gall, 2020. Dear Mental Health Practitioners, Take Care of Yourselves: a Literature Review on Self-Care. International Journal for the Advancement of Counselling
5 Ayala et al., 2017. What Do Medical Students Do for Self-Care? A Student-Centered Approach to Well-Being. Teaching and Learning in Medicine
7 Narasimhan et al., 2019. Self-care interventions to advance health and wellbeing: a conceptual framework to inform normative guidance. British Medical Journal
8 Healthcare and Self-Care: A Look Inside Patient and Physician Perspectives on Self-Care https://drwaynejonas.com/wp-content/uploads/2019/07/health_and_self-care_report_FNL.pdf.
9 Nichols et al., 2020. Self-care for health: a national policy blueprint. Mitchell Institute, Victoria University, Melbourne.