SELF-CARE BEHAVIOR

Self-care behavior, a key concept in health promotion, refers to decisions and actions that an individual can take to cope with a health problem or to improve his or her health. Examples of self-care behaviors include seeking information (e.g., reading books or pamphlets, searching the Internet, attending classes, joining a self-help group); exercising; seeing a doctor on a regular basis; getting more rest; lifestyle changes; following low fat diets; monitoring vital signs; and seeking advice through lay and alternative care networks, evaluating this information, and making decisions to act or even to do nothing. Self-care is generally viewed as a complement to professional health care for persons with chronic health conditions. Self-care behavior is, however, broader than just following a doctor's advice. It also encompasses an individual's learning from things that have worked in the past.

Presumed benefits of self-care include lower costs for the health care system; more effective working relationships between patients and physicians and other health care providers; increased patient satisfaction; and improved perceptions of one's health condition. Self-help behaviors have been shown to lessen pain and depression and to improve quality of life. However, a relationship between self-care behaviors and positive physiological outcomes has not been proven. Generally, health care practitioners encourage and support patients to practice self-care behaviors because patients then actively participate in their own care. However, many practitioners experience difficulty in offering advice on self-care behaviors because they are not aware of specific techniques, strategies, and supports that patients can use.

Within a health promotion context that views health as a resource for daily living, self-care is seen as empowering. Through acquisition of self-care skills, people are able to participate more actively in fostering their own health and in shaping conditions that influence their own health.

DEFINITIONS OF SELF-CARE

No single definition of self-care behavior has been broadly accepted. Definitions vary as to (1) who actually engages in self-care behavior (e.g., individual, family, community); (2) what prompts self-care behaviors (e.g., to practice health promotion, to prevent illness, to limit the impact of illness, to restore health); and (3) the extent to which health care professionals are involved.

The World Health Organization defines self-care as "activities individuals, families, and communities undertake with the intention of enhancing health, preventing disease, limiting illness, and restoring health. These activities are derived from knowledge and skills from the pool of both professional and lay experience. They are undertaken by lay people on their own behalf, either separately or in participative collaboration with professionals." Other experts define self-care in terms of individual behavior when a person functions on his or her own behalf in health promotion and prevention or in disease detection and treatment. In this definition, self-care behaviors occur without professional assistance, but individuals are informed by technical knowledge and skills derived from both professional and lay experience. Still others define self-care as involving activities to enhance health, prevent disease, evaluate symptoms, and restore health—either with or without participation by professionals.

PREVALENCE

Studies report that 80 to 95 percent of all health problems are managed at home through self-care and that most people who consult a physician have tried treating themselves before seeking medical advice. The seriousness of the health problem and the extent and type of disability, including its affect on daily activities, are the best determinants of whether an individual uses self-care practices or seeks help from a professional. In one study of older persons, J. Norburn and colleagues (1995) found that race, gender, education, place of residence, and socioeconomic status did not significantly influence the likelihood of self-care behaviors. Persons with chronic health conditions often become more knowledgeable about their conditions than the average health care professional, and they frequently participate in group or community self-care educational and support programs.

HISTORICAL DEVELOPMENT

Some authors discuss self-care as a kind of social movement and not in terms of specific health-related behaviors and activities. A major influence in the modern interest in self-care developed in the 1960s with the advent of social movements, such as the women's movement and consumerism. Such movements were concerned with issues of autonomy, self-determination, and independence in both health and illness. A shift from physician-dominated health care was catalyzed by the realization that individuals play a large role in directing their own health and therefore they should become more involved in making decisions that affect their health. During the following decades, several factors contributed to the growth in self-care, including a shift in patterns of disease from acute to chronic illnesses; a change in emphasis from cure to care; an increasing discontent with excessive technology and depersonalized medical care; a growth in lay knowledge; a desire for increased personal control in interactions with health care professionals; a need to control escalating health care costs; an increased level of education and knowledge among the general population; a broader dissemination of health-relevant information; a greater emphasis on the rights of consumers; and an increasing knowledge about the importance of lifestyles for longevity and quality of life.

Self-care now is concerned with development and use of personal health practices and coping skills, making decisions involving consulting others (including lay persons and professionals), and using one's own resources to manage health problems.

Several health care disciplines have achieved consensus on what characterizes self-care. Self-care is situation and culture specific; involves the capacity to act and make choices; is influenced by knowledge, skills, values, motivations, control, and confidence; and it focuses on aspects of health care under individual control, as opposed to aspects governed by social policy or legislation.

THEORETICAL APPROACHES TO SELF-CARE

In general, researchers have relied on existing, general theories of behavior change to explain self-care. These major theories include the social learning theory, the health belief model, the theory of reasoned action, and the transtheoretical model of behavior change. They have met with varying degrees of success in explaining self-care practices and why some people do or do not engage in these activities.

Two theories are specific to self-care: D. E. Orem's theory of self-care (1991), which is a conceptual theory and not empirically derived, is specific to managed-care environments in which nursing interventions occur; and the self-regulation model of self-care developed by E. Leventhal, H. Leventhal, and C. Robitaille.

This latter theory has been tested to a limited extent and appears to hold promise in explaining why people do or do not engage in self-care behavior. It posits that an individual's differences and motivations play a critical role in explaining decisions to initiate and sustain self-care behaviors. The following diagram illustrates the basics of this theory.

In this model, an individual's reality and the emotional reactions to this reality interact. Concurrently, action plans and procedures for managing the symptoms are generated. Finally, there is an appraisal of anticipated and actual outcomes, with this feedback possibly leading to changes in emotional reactions and perceptions of reality, which in turn lead to changes in action plans, and so forth. This theory essentially explains how people represent and manage health threats and how this changes over time in relation to experiences and the course of the health threat.

Patrick McGowan

(see also: Alternative, Complementary, and Integrative Medicine; Behavior, Health-Related; Breast Self-Examination; Contraception; Enabling Factors; Folk Medicine; Foods and Diets; Health Belief Model; Internet; Predisposing Factors; Self-Help Groups; Theory of Reasoned Action; Transtheoretical Model of Stages of Change; Wellness Behavior )

Bibliography

Dean, K. (1986). "Lay Care in Illness." Social Science Medicine 22:275–284.

—— (1996). "Self-Care Behavior: Implications for Aging." In Self-Care and Health in Old Age: Health

Figure 1

Behavior Implications for Policy and Practice, eds. K. Dean, T. Hickey, and B. E. Holstein. London: Croom Helm.

Gantz, S. B. (1990). "Self-Care: Perspectives from Six Disciplines." Holistic Nursing Practice 4(2):1–12.

Health Promotion and Programs Branch, Health Canada (1997). Supporting Self-Care: The Contributions of Nurses and Physicians. Ottawa: Minister of Public Works and Government Services Canada.

Leventhal, E.; Leventhal, H.; and Robitaille, C. (1998). "Enhancing Self-Care Research: Exploring the Theoretical Underpinnings of Self-Care." In Self-Care in Later Life: Research, Program, and Policy Perspectives, eds. M. Ory and G. DeFriese. New York: Springer.

Levin, L.; Katz, A.; and Holst, E. (1976). Self-Care: Lay Initiatives in Health. New York: Prodist.

Norburn, J.; Bernard, S.; Konrad, T.; Woomert, A.; DeFriese, G.; Kalsbeek, W.; Koch, G.; and Ory, M.(1995). "Self-Care Assistance from Others in Coping with Functional Status Limitations among a Sample of Older Adults." Journal of Gerontology: Social Sciences 50B:S101–S109.

Orem, D. E. (1991). Nursing: Concepts of Practice. St. Louis, MO: Mosby.

World Health Organization (1983). Health Education in Self-care: Possibilities and Limitations. Geneva: Author.