Taking charge of your health

Many patients feel ill-prepared for discharge from rehabilitation, despite having undergone extensive periods of therapy¹. Training and increased awareness of self-management techniques for healthcare professionals, incorporated with their current mainstream clinical services, could offer new opportunities for patients to take charge of their lives and return to functional independence; and if integrated effectively, could help address the problem experienced by many patients after discharge from rehabilitation², with confidence.

What is Self-Management?

Self-management refers to an individual’s “active participation in managing their own symptoms, treatment, physical and psychosocial consequences” that are inherent in the aftermath of chronic illness; and, due to the diverse recovery needs of patients, it is essential for these individuals to develop adequate knowledge and skills, through interventions, for better self-management of their health problems in daily living³. Patients, with long-term conditions, will spend 99% of their lives managing their own condition; without interactions from Healthcare Practitioners. If they are reliant on family, the community, or healthcare professionals to assist them constantly, they will be heavily dependent and have serious participation restrictions.

Self-Management Interventions (SMI)

There is good evidence in literature that supports a self-management approach to healthcare provision works; and that self-management interventions (SMI’s) designed for chronic conditions, have shown a positive impact on quality of life, clinical outcomes, and overall healthcare service use of individuals⁴. SMIs are designed to empower individuals to manage their health more effectively; and engagement in SMIs is seen as the key to promoting recovery and facilitating improved health outcomes⁵. SMIs, due to their nature of improving one’s self efficacy, and encouraging individuals to manage their own symptoms, treatment, and lifestyle changes, are preferred in resource constraint environments (such as in South Africa); as they empower and allow for the individual to take ownership of their healthcare and rehabilitation, and therefore reduce the burden of care on the limited available community healthcare rehabilitation resources⁶.

According to the Healthcare 2030 Road to Wellness report delivered by the Western Cape Department of Health⁷, South Africa is in the process of re-imagining its approach to healthcare provision and service delivery; with the main focus and vision for 2030 being on achieving “A person-centred approach”. This re-imagined approach sees a strengthening of the Primary Health Care (PHC) service platforms, of which community-based services are one – “A central tenet of the PHC philosophy is community involvement in health, which implies that the community takes ownership and responsibility for its own healthcare at a personal level”. As part of this process, the WCDOH committed to advance the need for a “Philosophical and practical paradigm shift amongst healthcare workers from health ‘providers’ to health ‘facilitators / enablers’, in order to promote co-responsibility for increasing and sustaining wellness. This is important to remove the notion of dependency on health providers and to promote individual / community capacity and responsibility for the health and care of self and others” ⁷.

Self-Management Skill Development

In order to achieve effective self-management however, it is vital that individuals are actively involved in learning multiple self-management skills³, such as: Goal setting, reflection, problem solving, resource utilisation, self-discovery, knowledge, and decision-making. The use of language when supporting the development of the above-mentioned self-management skills in our patients is one of the most important tools we have as Healthcare Professionals; where the right phrases and questions need to be asked in order to effectively facilitate and support self-management development. For example, when engaging an individual with a challenging task ahead of them, instead of giving them the solution to overcome it, ask: “How do you think you could overcome this?”; in doing so, allowing for critical thinking and problem solving to occur, and offering just the right amount of support through facilitation.

Development of these skills also requires a degree of self-efficacy on the part of the individual⁸, whereby self-efficacy has an effect on each of these skills; therefore, enhancing self-efficacy means enhancing self-management.

Dr. Ryan Groenewald is the Practice Manager at Physiotherapy@Home, which is a partner of Medwell SA – The Home Health Care Specialists.  For more information visit www.physiotherapyathome.co.za or www.medwell.co.za

References

1. Jones, F., Mandy, A., & Partridge, C. (2009). Changing-self-efficacy in individuals following a first time stroke: Preliminary study of a novel self-management intervention. Clinical Rehabilitation, 23(6), 522-533.
2. Hale, L., Jones, F., Muligan, H., Levack, W., Smith, C., Claydon, L., … & Flannery, J. (2014). Developing the Bridges self-management programme for New Zealand stroke survivors: A case study. International Journal of Therapy and Rehabilitation, 21(8), 381-388.
3. Lo, S. H. S., Chang, A. M., Chau, J. P. C., & Gardner, G. E. (2013). Theory-based self-management programmes for promoting recovery in community-dwelling stroke survivors: A systematic review. JBI Database of Systematic Reviews and Implementation Reports, 11(12), 157-215. Available at: https://www.joannabriggslibrary.org/jbilibrary/index.php/jbisrir/article/view/1056.
4. de Silva, D. (2011). Helping people help themselves: A review of the evidence considering whether it is worthwhile to support self-management. London: The Health Foundation. Available at: https://www.health.org.uk/sites/health/files/ HelpingPeopleHelpThemselves.pdf.
5. Boger, E. J., Demain, S., & Latter, S. (2013). Self-management: A systematic review of outcome measures adopted in self-management interventions for stroke. Disability and Rehabilitation Journal, 35(17), 1415-1428.
6. Lennon, S., McKenna, S., & Jones, F. (2011). Self-management programmes for people post-stroke: A systematic review. Clinical Rehabilitation, 27(10) 867–878.
7. Western Cape Department of Health. (2014). Healthcare 2030: The road to wellness. Available at: https://www.westerncape.gov.za/assets/departments/ health/healthcare2030.pdf.
8. Riazi, A., Aspden, T., & Jones, F. (2014). Stroke self-efficacy questionnaire: A Rasch-refined measure of confidence post-stroke. Journal of Rehabilitation Medicine, 46(5),406-412.