What is Self-Care?

There are a number of definitions of self-care produced by different authorities at different times – the World Health Organisation for example has produced three much-cited definitions (in 1983, 1998 and 2009). The WHO 1998 definition is:

‘Self-Care is what people do for themselves to establish and maintain health, and to prevent and deal with illness. It is a broad concept encompassing hygiene (general and personal), nutrition (type and quality of food eaten), lifestyle (sporting activities, leisure etc), environmental factors (living conditions, social habits, etc.) socio-economic factors (income level, cultural beliefs, etc.) and self-medication.’

Different definitions include or emphasise different aspects of self-care. A discussion of the different definitions of self-care has been published (Webber et al. Self-Care in Health: We can define it, but should we also measure it? SelfCare 2013 4(5): 101-106). The range of definitions of self-care, together with the broad and disparate activities that are part of self-care, can lead to definitions of this sort becoming unwieldy for practical purposes.

What is needed for practical implementation of self-care is a description of the all the elements positioned from the individual’s point of view. ISF therefore proposes that a framework for self-care can conveniently be visualised and organised around seven ‘pillars’ or ‘domains’:

  1. Health literacy – includes: the capacity of individuals to obtain, process and understand basic health information and services needed to make appropriate health decisions
  2. Self-awareness of physical and mental condition – includes: knowing your body mass index (BMI), cholesterol level, blood pressure; engaging in health screening.
  3. Physical activity – practicing moderate intensity physical activity such as walking, cycling, or participating in sports at a desirable frequency.
  4. Healthy eating – includes: having a nutritious, balanced diet with appropriate levels of calorie intake.
  5. Risk avoidance or mitigation – includes: quitting tobacco, limiting alcohol use, getting vaccinated, practicing safe sex, using sunscreens.
  6. Good hygiene – includes: washing hands regularly, brushing teeth, washing food.
  7. Rational and responsible use of products, services, diagnostics and medicines – includes: being aware of dangers, using responsibly when necessary.

The seven pillars illustrated schematically:

seven-pillars-self-care

The focus of the International Self-Care Foundation is on self-care in the preservation of wellness in healthy people, to help prevent the epidemic of lifestyle diseases. This is where the greatest need lies currently. However, it is important to emphasise that self-care is also essential for people with an existing disease condition, and this is also sometimes referred to as ‘self-management’ of the condition.

Self-care is also usually the first treatment response to everyday health conditions and common ailments. Overall, an estimated 70% to 95% of all illnesses are managed without the intervention of a doctor. Knowing when to consult a healthcare professional is a self-care skill under pillar 1 (health literacy) and pillar 2 (self-awareness).

Self-care is therefore the fundamental level of health care in all societies and should be seen as a major public health resource. Yet self-care is often unrecognised and underappreciated, leading to comparisons with the invisible majority part of an iceberg below the surface, or to a hippopotamus in those countries in latitudes less familiar with icebergs.

self-care-iceberg
self-care-hippo

More on definition of self-care

Definitions of self-care have evolved over time. Commonly quoted definitions are as follows (chronological order):

 “Self Care in health refers to the 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.”

World Health Organization (WHO). Health Education in Self-Care: Possibilities and Limitations. Report of a Scientific Consultation. Geneva, Switzerland. November 21–25, 1983.

“Self-Care is what people do for themselves to establish and maintain health, and to prevent and deal with illness. It is a broad concept encompassing hygiene (general and personal), nutrition (type and quality of food eaten), lifestyle (sporting activities, leisure etc.), environmental factors (living conditions, social habits, etc.), socio-economic factors (income level, cultural beliefs, etc.) and self-medication.”

WHO. The role of the pharmacists in self-care and self medication: report of the 4th WHO consultative group on the role of the pharmacist. Geneva, 1998.

“Self-Care is a lifelong habit and culture. It is the action individuals take for themselves and their families to stay healthy and take care of minor and long term conditions, based on their knowledge and the information available, and working in collaboration with health and social care professionals where necessary”.

UK Department of Health Steering Group. Joining Up Self-Care in the NHS. 2003

 “Self care is a part of daily living. It is the care taken by individuals towards their own health and well being, and includes the care extended to their children, family, friends and others in neighbourhoods and local communities. Self-Care includes the actions individuals and carers take for themselves, their children, their families and others to stay fit and maintain good physical and mental health; meet social and psychological needs; prevent illness or accidents; care for minor ailments and long-term conditions; and maintain health and wellbeing after acute illness or discharge from hospital.”

UK Department of Health. Self-Care – A Real Choice. 2005.

“Self-Care is the ability of individuals, families and communities to promote health, prevent disease, and maintain health and to cope with illness and disability with or without the support of a health-care provider”.

WHO SEARO. Self-Care in the Context of Primary Health Care. Report of the Regional Consultation Bangkok, Thailand. 7-9 January 2009.

Some general observations about these definitions may be made. Self-care definitions commonly include individuals, their families, friends and communities. Community-level action to support people in self-care will be of increasing importance in future.

There is an emphasis on the prevention of disease or illness and the maintenance of wellness. In this the definitions are aimed primarily at healthy people.

This is not to say that self-care is unnecessary or inappropriate for people with an existing disease condition. Self-care in this situation is essential and is sometimes referred to as ‘self-management’ of the condition.

Self-care is personal healthcare oriented around the individual, but does not exclude healthcare professional support. A current focus of attention in self-care includes recognition of new roles for healthcare professionals in ‘collaborative care.’

In fact, knowing when to consult a healthcare professional is an important judgement that a self-caring person must make, and should be the result of a self-determined self-care decision-making process. The role of patient in symptom recognition and minor ailment diagnosis is relevant in this context.

More recent definitions have included a focus on risk factors and risk factor avoidance in areas such as personal injury and accidents.

The concept of health promotion is emerging and will be of increasing importance in future.

Self-medication is mentioned in the pharmacist-context definition, meaning ‘responsible’ self-medication with non-prescription (over-the-counter, OTC) medicines. Self-medication with prescription medicines is unfortunately a common practise in many countries but is undesirable and potentially dangerous. By contrast, rational and responsible use of prescription medicines under the supervision of a doctor is an important self-care activity where responsibility ultimately lies with the individual.

For a further discussion on self-care definitions see the following paper: David Webber, Zhenyu Guo and Stephen Mann. Self-Care in Health: We can define it, but should we also measure it? SelfCare 2013 4(5):101-106.

 

 

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