Self-Help and Self-Management Flashcards
What is self-management? (4)
Taking charge of one’s health
Dealing with symptoms and change over time
Working more effectively with healthcare professionals
Improving one’s quality of life
Long term conditions are increasing. How many people in the UK have a long term condition?
15 million
People with LTCs account for about ___% of GP appointments, ___% of all outpatient appointments and over ___% of all inpatient bed days.
50%
64%
70%
How is deprivation linked to morbidity/LTCs?
Multiple morbidity is more common in people who are over 60, and those who live in deprived areas.
People who live in deprived areas are more likely to develop LTCs earlier than those in more affluent areas.
What needs to be managed? (8)
Monitoring of symptoms and responding appropriately Taking Medications Making Behavioural Changes Making Role Adjustments Managing Emotional Impact Negotiating with Medical Team Decision Making Accepting Condition
What is the published estimate of general adherence?
60%
What is average rate for taking medicine for acute illness with short term treatment?
78%
What is the average rate for taking medicine for chronic illness with long term treatment?
54%
What is the average rate for taking medicine to prevent illness?
60%
What is the typical rate for lifestyle changes?
2-10%
What social changes facilitate self-management? (5)
- Increased (but not universal) access to telephones and the internet
- DoH emphasis on primary prevention, increased promotion of self-checking behaviours, engaging with healthy lifestyles, mass media campaigns.
- Rejection of paternalistic models of care, rise of empowerment movements.
- Changes in social attitudes to smoking, obesity and so on
- Legal changes such as the smoking ban, sugar tax
What makes self-management difficult? (8)
Issues of understanding and remembering
Regimes may be complex and changing
Regime may require changing long term habits like smoking
Not everyone wants to self-manage
People often don’t self-manage chronic conditions very well and lose motivation
Often have more than one condition
Lack of social support
Environment affects attempts to maintain lifestyle changes
What causes unintentional non-adherence?
Forgetting
What is meant by primacy and recency effects?
Patients will remember what they are told first and last
How is intelligence related to unintentional non-adherence?
It isn’t - more intelligent patients do not remember more than less intelligent patients
How is anxiety related to unintentional non-adherence?
Moderately anxious patient recall more than highly anxious or not-at-all anxious patients
Why might a patient not adhere? (7)
Complexity of treatment Cost of prescriptions Cost of travel Can't find childcare Can't take time off work Mobility limitations Inconvenient health-care hours
What issues arise from the consultation that affect adherence? (3)
Failure to agree on a diagnosis
Lack of agreement about the correct treatment
Dissatisfaction with the interaction/feel they have not been listened to
What concerns about medications might patients have that cause them not to adhere? (4)
Concerns about side effects
Worries about dependency
Beliefs about what is ‘natural’ and ‘unnatural’
Disruption to lifestyle – taking medication every day, at certain times of day
What affects adherence (black flow chart/model)? (3)
- Perceived need and illness perceptions
- Concerns (e.g. about side effects) and background beliefs
- Contextual issues (e.g. past experiences, practical difficulties, self-efficacy, satisfaction, cultural influences, views of others)
What are self-management programmes?
What conditions do they tend to be used for?
What are they based on?
People learning to manage their illness in such a way as to have best control over symptoms and Health Related Quality of Life.
LTCs
Based on cognitive behavioural techniques/theories of behaviour change
Expert patient programmes - what theory is this based on?
Social Cognition and Social Learning Theory (Bandura 1977)
How do EPPs work? (4)
Increase self-efficacy/confidence by setting and achieving goals
Improve QOL by helping patients feel more in control
Empowers patients to use their knowledge
Teaches patients how to communicate better to improve quality of doctor-patient interactions
What elements comprise the social cognitive theory? (5)
Socio-structural factors (facilitators, impediments)
Self-efficacy
Goals
Outcome expectancies (physical, social, self-evaluative)
–> Behaviour
What’s happening in the self-management group for people with HIV called Positive Self-Management Programme? (4)
Why does it not work for everyone in the same way? (3)
Modeling of self-management behaviours, mastering of skills, reinterpretation of symptoms and social support
Not everyone can engage in the same way, depends where they are psychologically in relation to their HIV
Social and material needs could not be addressed
The social support was of an exclusive kind (extending only to members of the group).
Self-management training – are changes maintained?
They are sustained but no further changes are made - this suggests that attendance can lead to longer-term changes, e.g. self-efficacy and self-management behaviours.
What improvements are seen with self-management training? (5)
Cognitive symptom management Self-efficacy Communication with doctor Fatigue Anxiety and depression and health distress
What is social support? (3)
Is it always helpful?
The perceived comfort, caring, esteem or help received from others
The existence/quantity of social relationships
The assistance people believe is available to them/the amount actually received
NO - not all social support is equal/welcome/helpful
What is meant by instrumental support?
Physical help
What other different kinds of support are there?
Esteem suport Support/advice Companionship Structural/network support Functional support
What does structural support mean?
Type, size, density and frequency of contact available
What does functional support mean?
Perceived benefit provided by the structure. Available and enacted support.
How might social support be assessed? (2)
Social Support Questionnaire
Quality of relationships questionnaire
Which has been more consistently related to beneficial health outcomes - perceived or received support?
Perceived
What is meant by optimistic bias?
Exaggerated expectations of support may lead to disappointment when need arises
What may happen to initial support?
May dissipate over a long time span of crisis (e.g. burn out, physical exertion, frustration)
In general, the best support comes from…?
the people we are closest to
When might social support be unhelpful/detrimental? (5)
Friends may encourage others to cope with depression by drinking alcohol or to solve other problems
Friends who underestimate the amount of stress one is feeling are unhelpful
Family and friends may set bad examples or interfere with healthy behaviour.
Support agents may react in a way that makes the problem worse
Support providers may be adversely effected by providing support (e.g. caregiving).
In terms of the cardiovascular system, high level of social support is associated with…
Lower heart rates and blood pressure
What is the buffering effect?
Social support leads to better health by protecting people from the negative effects of high stress (indirect effect).
What is the effect of overprotection?
Perceived overprotection associated with anxiety, depression and lower health related QoL
What are the different styles of support? (5)
Participative Regulative Observational Incapacitated Dissociative
What is self-help?
Can mean joining a group of people with similar health issues (can be peer of expert led)
Can equally take on the form of books, DVDs, online courses, virtual groups/forums (for individuals who would rather not join a group)
What are the two models for self-help groups?
Peer led and managed
Professionally operated
How are social representations of chronic disease transformed in a self-help group? (5)
From helplessness and negativity to seeing disease as something that can be lived with Normalisation of the illness Social support improved Better listening to each other and HCP Taking less medication
What makes self-help groups work? (5)
Normalising conditions and sharing experiences
Sharing knowledge and resources
Emotional support
Learning from others
A place to talk honestly without upsetting family members
What potential issues are there in self-help groups? (4)
One or two members who dominate and others who don’t speak at all.
Angry/aggressive group members
Victim blaming
Discouraging engagement with medicine
