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Self Care Interventions to Advance Health and Wellbeing

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Self Care Interventions to Advance Health and Wellbeing SELF CARE INTERVENTIONS FOR SEXUAL AND REPRODUCTIVE HEALTH Self care interventions to advance health and BMJ: first published as 10.1136/bmj.l688 on 1 April 2019. Downloaded from wellbeing: a conceptual framework to inform normative guidance Manjulaa Narasimhan and colleagues argue that there is a pressing need for a clearer conceptualisation of self care to support health policy elf care existed well before formal promote health, prevent disease, maintain another focused on how self care relates health systems and is an impor- health, and cope with illness and disability to the health system: people centred and tant contributor to health out- with or without the support of a health-care system centred. comes. For many people, self care provider.”5 6 While this is a broad definition The capacity and ability of an individual within well established cultural that includes many activities, it is impor- to make informed health decisions and Sand social norms may be the only health- tant for health policy to recognise the make use of available health resources is an care they access. Where healthcare systems importance of self care, especially where it important component of effective prevention do exist, self care remains a crucial compo- intersects with health systems and health and management of a health condition. nent for maintaining health. For example, professionals (fig 1). The recent global con- The ability to access and use societal and brushing teeth is a daily self care practice ference on primary health care, which cele- familial resources contributes to personal in which individuals are in control of their brated the 40th anniversary of the Alma Ata agency and autonomy and determines dental health, but it can link to healthcare declaration, again underlined the impor- health outcomes. Seen thus, self care is should check-ups or advanced interven- tance of empowering and supporting peo- about caring and the relational context, tions be needed. Moreover, interventions ple in acquiring the knowledge, skills, and finding ways to enable good self care and that were previously available only through resources needed to maintain their health avoid social and cultural iatrogenesis of facility based healthcare providers are now or the health of those for whom they care.7 self medicalisation.8 From this perspective, http://www.bmj.com/ being accessed in the self care environ- A growing globalised market of drugs, the capacity to meet physical, physiological, ment. Pregnancy tests, for instance, have diagnostics, and devices, coupled with psychological, and self fulfilment needs is transitioned to self care. rapid advances in digital technologies, important.9 Self care interventions in the health sector is making new configurations of self care Given the potential to enhance health have increased since the primary healthcare possible. Many of these interventions will and wellbeing, self care is an important movement began,1 fuelled by an increased be regulated, but many more will not. Given component of people centred care.6 A people focus on empowering women,2 improving the increasing number of new interventions, centred framing emphasises psychological, the intrinsic capacity of older people,3 and the importance of linkage to care, and the empowerment, and self fulfilment needs,10 on 23 September 2021 by guest. Protected copyright. the role of self care in the management of supportive part the health system can placing less emphasis on technical activities chronic diseases, including mental health.4 play, there is a pressing need for a clearer and instead looking at self care in terms of The World Health Organization’s working conceptualisation of self care to support capacities, building on a person’s “health definition of self care includes “the ability health policy. assets,” both as a condition for and a of individuals, families and communities to product of the practice of self care.11 System and people centred framing of self care A complementary perspective on self Self care ranges from a set of activities to care is a “system centred” framing, which KEY MESSAGES a set of capacities. It is possible to think focuses on activities that can add value in • Self care interventions increase about self care from two complementary dealing with specific diseases or health choice, accessibility, and affordability, perspectives, one focused on improving issues that healthcare managers and as well as opportunities for individuals the capacity of individuals to self care and policy makers consider important. The to make informed decisions regarding their health and healthcare Health systems Everyday life • Self care interventions may also exac- erbate inequalities and therefore need Self management, to be monitored and, where appropri- self medication, self treatment, self examination, self injection, ate, linked with health systems self administration, self use • Self care can be thought of using two Self care complementary frames: people cen- Self testing, Self awareness, tred and system centred. self sampling, self screening, self help, self education, Normative guidance will be essential self diagnosis, self collection, self regulation, self efficacy, • self monitoring self determination to redraw the boundaries of a stronger healthcare system that includes self care Fig 1 | Self care in the context of interventions linked to health systems the bmj | BMJ 2019;365:l688 | doi: 10.1136/bmj.l688 1 SELF CARE INTERVENTIONS FOR SEXUAL AND REPRODUCTIVE HEALTH dominant paradigm from this perspective framework to support WHO normative and information, appropriately tailored to is summarised by a Kaiser Permanente guidance (fig 3). The aim of the framework different needs. BMJ: first published as 10.1136/bmj.l688 on 1 April 2019. Downloaded from pyramid12 that features self care as distinct is to support healthcare policy makers and Individuals can be in control of some self from, but complementary to, professional implementers who are thinking through the care interventions, such as using condoms; healthcare (fig 2).12 From this perspective, complexity of promoting high quality self while others, such as a positive HIV self test, the effect of self care on health outcomes care for individuals. The framework aims to will require confirmation within a healthcare and its division from professional care are ensure that all individuals are considered, setting; and others still, such as self sampling key considerations. Promoting task shifting including those who may not be aware of of HPV, will require the health setting to do or sharing between professionals and the their right to health and those who may fall the test. This dynamic interaction between general public or optimising the linkage to through the cracks of the existing healthcare individuals and the health system can also professional care are priorities to harness system. change over time in line with the needs and self care to enhance specific health system Naturally, given the importance of a choices of individuals. The health system outcomes.13 14 In this framing, the focus is on people centred approach, self carers and supporting people for self management of managing and mitigating health concerns or care givers are at the centre of the framework health conditions remains an integral part risk factors. that is focused on health and wellbeing. The of self care. key principles for promoting self resilience, Accountability for health outcomes is Conceptual framework for self care autonomy, and agency in any health policy reflected at multiple levels in the conceptual Individuals choose a self care health inter- guidance for self care are recognising framework, and accountability of the health vention for many positive reasons, includ- human rights, sex equality, and other ethical sector remains a key factor in the equitable ing convenience, cost, empowerment, and considerations. Two further key principles support to quality self care interventions. a better fit with values or lifestyle. A proved include taking a holistic approach to health Meaningful community engagement where efficacy and endorsement by the health sys- and recognising that needs change across a self care is championed and advocated by tem may be another reason to choose self person’s life course. patient groups is also an essential factor in care interventions. The conceptual framework recognises the success of linkage to care. Given that an ideal, well functioning health that in addition to the traditional self system is seldom a reality, particularly in care practices that societies have passed Self care for sexual and reproductive health resource constrained settings, individuals on through generations, people are and rights may also opt for self care interventions accessing new information, products, and While self care is important in all aspects to avoid the health system owing to poor interventions through stores, pharmacies, of health, it is particularly important and quality services or because information, and the internet. Digital health and mobile challenging to manage for populations http://www.bmj.com/ interventions, or products are inappropriate, technologies are increasing rapidly, not only negatively affected by sex, political, cul- unaffordable, or inaccessible. Stigma as places of access but in many other aspects tural, and power dynamics. This is true from healthcare providers or from within of self care.16 for sexual reproductive health and rights, families and communities may be another
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