Self-care within a model for demand for medical care

Self-care among older people living with chronic conditions

PURPOSE

The aim of this study was to clarify the concept of self-care among older people living with chronic health conditions. This concept clarification will assist nurses in addressing self-care among older people through research, policy and practice in offering an expanded conceptual model.

BACKGROUND

Several policy influences over the past decade directly relate to the increased importance and economic necessity to require self-directed care for older people living with chronic health conditions to maintain their care at home in the community.

METHOD

A selective review of literature on the concept of self-care included 31 sources. The Norris Concept Clarification method (1982) was used for clarification. The phenomenon is described historically according to its antecedents, attributes and consequences.

RESULTS

A proposed definition is provided based on the clarification of this concept. A conceptual model is presented through an ecological framework. Self-care among older people living with chronic conditions is multidimensional and has multilevel influences (individual, community, system levels) and is mediated by the contexts and processes of ageing. Self-care originates along one's life course and is learned. Self-care responses are based on care needs when living with chronic health conditions.

CONCLUSION

Self-care is an individual capacity, disposition and activity older people manifest in living with multiple chronic conditions. These features (capacity, disposition, action) influence one another and are hierarchical and continuous. Research, practice and policies that promote self-care among older people can focus on these features to improve health outcomes and promote new models of care consistent with personal development and chronic care needs in older age.

IMPLICATIONS FOR PRACTICE

This concept clarification can offer a model to support self-care among older people living with chronic conditions.

Systems of Parent Care within Sibling Networks

This article examines factors related to the participation of adult children in their elderly parents' helping networks. A three-stage decision model was tested which predicts the likelihood that: (a) an adult child is named as a helper by elder respondents who have at least one living child; (b) an adult child is chosen as the primary helper in networks including at least one adult child; and (c) among those networks containing at least one son and one daughter (one of whom was named as the primary helper), a son is selected rather than a daughter as the primary helper. The analysis revealed the importance of geographic proximity in predicting the involvement of adult children in parental helping networks. The integral role of daughters and other female family members was also highlighted. Other factors, such as parents' marital status, gender, level of functional impairment, and family structure, were also examined.

Mass media health information available to young adults in the United Kingdom: (1) Daily newspapers and magazines

Consumers are increasingly challenging community pharmacists with mass media advertisements and news items. This has the potential to produce conflict as professional judgment, editorial priorities and advertising practices are inevitably not aligned. To explore the characteristics and distribution of health information in publications read by young adults (15- to 24-year-olds) in the United Kingdom, four newspapers and 29 magazines were surveyed over an eight-week period in January/February 1997. Nine hundred health items were found in 84 newspaper issues and 80 magazine issues. Newspapers commonly included health information in the form of advertisements and news items; magazines included features and readers' letters. Descriptions of disease treatment and states were the most common subjects. Although conventional therapies were featured more often than alternative options, there was a considerable number of advertisements and features for alternative therapies, especially in newspapers. Most therapeutic areas were included, but the central nervous system was the most prevalent. One hundred and ninety-six newspaper items (40.2 per cent), and 193 magazine items (46.8 per cent) referred to a specific drug or medicine. The drug properties most often described were indication and formulation. Side effects were more likely to be included in magazine items. There was a notable lack of references to professional information sources. Community pharmacists must be aware of the characteristics of this information to help consumers to make better informed self care decisions.

Mass media health information available to young adults in the United Kingdom: (2) Television and radio

In order to examine health information given in television and radio broadcasts popular with young adults (15- to 24-year-olds) in the United Kingdom, three terrestrial television channels and six radio stations were surveyed over eight weeks, using methodology described previously. One hundred and eighty-seven health items were found during 54 hours of television and 58 hours of radio broadcasting. Television commonly included health information within programme storylines and advertisements; radio included advertisements and news items. Descriptions of disease treatment and states were the most common subjects on television, but radio also covered substance misuse and sexual health issues. The central nervous system was the most prevalent therapeutic area. Ninety-two television items (56.8 per cent) and 15 radio items (60.0 per cent) referred to a specific drug or medicine. The drug properties most often described were indication and formulation. Side effects were more likely to be reported on the radio, and hazards were a major issue within items about substance misuse. As with the first part of this study, which reported on health information given in the press (p180), references to contacting any professional sources for further information were rare, and certainly do not lead young consumers to expect to be questioned about the appropriateness of products when subsequently purchasing them. This study challenges community pharmacy to reconsider how it best continues to discharge its consumer protection role in an era of increasing consumer empowerment.

Dietary pattern of self-care among Asian and Caucasian diabetic patients

Diabetes mellitus is a growing pandemic and its self-care management rests primarily with the individual. This qualitative case study investigated the self-care dietary pattern among a group of 25 Asians and 24 Caucasians diagnosed with type 1 or type 2 diabetes. Data collected from a semi-structured interview and a 7-day health diary explored the self-care activities undertaken by the participants to establish metabolic control. From an analytical perspective, the collective responses were placed on a continuum ranging from strict adherence, moderately flexible adherence to very flexible adherence. The findings suggest that most of the participants were located in the latter two categories of diet related to self-care. Implications for healthcare professionals in promoting self-care will be discussed.

A descriptive study of medical and chiropractic patients with chronic low back pain and sciatica: management by physicians (practice activities) and patients (self-management)

BACKGROUND

A practice-based study of ambulatory patients with low back pain noted a long-term outcome advantage for self-referred chiropractic (DC) patients over medical (MD) patients within a subgroup of patients with chronic low back pain and radiating pain below the knee. The frequency of self-care education by physicians in both provider cohorts coupled with current thinking on management of chronic low back pain led to an exploration and description of physicians' noncore practice activities and patients' self-management attitudes and behaviors.

METHODS

A longitudinal, practice-based, observational study was undertaken in 14 general practice and 51 chiropractic community-based clinics. We enrolled 2945 consecutive patients with ambulatory low back pain of mechanical origin; of these, 268 comprised the subgroup of patients with chronic low back pain and radiating pain below the knee. The patients' low back status was followed for 1 year. Data on physicians' practice activities were obtained from doctor questionnaires completed at each patient visit and from chart abstraction. Patient data obtained from self-administered questionnaires at enrollment included sociodemographics, complaint characteristics, health status, and health encounter preferences. Questionnaires mailed at 2 weeks, 1 month, 3 months, 6 months, and 12 months collected data on low back complaint status and satisfaction with treatment. At 1 to 3 years follow-up, mailed questionnaires collected data on patients' self-management attitudes and behaviors.

RESULTS

Physicians' core practice activities were as expected. Exercise plans and self-care education (>55%) were conspicuous in the frequency of their use in the DC cohort. MD patients appeared to rely more on family and friends for support during periods of back trouble. DC patients were characterized by greater self-efficacy motivation (P = .000). Both groups showed evidence of self-care activities during and between bouts of back pain, although MD patients were far more likely to choose bed rest (P = .007).

CONCLUSIONS

The chiropractic encounter may have enhanced patients' self-efficacy motivation, leading to better coping abilities and better pain and disability outcomes. Understanding, respecting, and capitalizing on the role and influence of psychosocial factors can help all physicians become more effective healers and counselors for their patients with back pain.

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

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.

Self-care responses to illness of patients with various cancer diagnoses

The purpose of this study was to examine the relationship between self-care responses and variables concerning health status, disease and treatment, socioeconomic resources, demographic characteristics, and health beliefs in a heterogeneous sample of 227 cancer patients referred to home care. Data were collected prior to discharge from the hospital using the OARS Functional Assessment Questionnaire, the Karnofsky Performance Status, the Multidimensional Health Locus of Control Scale, and the Preference for Participation in Care Tool. The results indicated that the variables related to health status, disease and treatment were highly correlated with self-care behavior (SCB), and to a lower extent to self-care preference (SCP). Karnofsky performance status, cancer-related impairments, perceived physical health, and stage of disease were identified as significant predictors of SCB explaining 57% of the variance. Age, gender, education, live-in resources, and perceived mental health were dominant predictors of SCP explaining only 17% of the variance. Further research endeavors should investigate other models that might prove to be better predictors of SCP.

The moderating effect of age on self-care

The study examined the moderating effect of age on the relations between symptom severity, self-care and others' care, patients' perception of the extent of problem solution, their satisfaction with the solution, and their perception of control over their health. Participating in the study were 121 female and 167 male chronically ill patients. Results indicated that age did play a major role in the relations between self-care and others' care and self-care outcomes. The young population sought maximum relief of symptoms with minimum effort from the self. The elderly, in contrast, could be said fo maximize control because what was important for them was not to depend on others but to be self-sufficient in solving their health problems.

Health diaries in nursing research and practice

Health diaries have been used in research and clinical practice to examine the daily symptoms of healthy and ill people, responses to symptoms, and efficacy of symptom response. This article describes current uses of health diaries in nursing research and practice, the types of typical health diaries, factors affecting the quality of diary data, and the costs and analytic issues related to health diaries. The implications of health diaries for nursing education, practice, and research are considered.

The production of health and the demand for health care in Finland

A structural equation model of the determinants of health and of the demand for health care, treating health status as a latent variable, was developed using cross-sectional sample survey data representing the adult noninstitutionalized population (n = 10,712) of Finland in 1987. Attention was paid to evaluating the relative effects of different factors affecting health and demand for health care in order to make generalizations for health policy. The maximum likelihood estimates of MIMIC (multiple indicators and multiple causes) models are presented. The results indicate the important role of lifestyle variables as health production factors, and stress the importance of decreasing smoking and reducing overweight as targets for health policy. Under the assumptions of the model, smoking and overweight also have considerable effects on health care utilization. The socioeconomic variables--income, education and occupation--seem to have almost equal impacts on health, although their separate direct effects are somewhat smaller than the effects of the two lifestyle factors. The results of demand for doctor visits and prescribed medicines stress factors such as time cost and the supply of doctors as important determinants of utilization, and confirm the fact that a significant portion of health utilization depends on doctors decisions and is generated by patient-doctor contacts.