With this year's Self Care Week imminent (13-19 November 2017), Co-chair of the Self Care Forum, Dr Selwyn Hodge Hon FRSPH, considers the importance of health literacy in ensuring the effectiveness of self-care.
One of the challenges for people today is to understand the meaning of terms used in unfamiliar contexts. Although we have become used to novel words being bandied about from technological research, confusion reigns when familiar words are used in different situations and with divergent meanings.
‘Wellness’ and ‘well-being’ are prime examples of this. I recently asked a number of individuals what they understood by these terms. Compared with my own interpretations, their answers varied considerably, with many stating they weren’t sure of the precise meanings (including a number of health professionals).
If you look for these words in a dictionary, ‘wellness’ often does not appear at all, whilst ‘well-being’ is mostly linked to comfortable life styles rather than to healthy living.
Experience shows that the term self-care is even more likely to cause confusion and disagreement. Some people interpret this expression as coping in the absence of direct help from health services; others relate it to looking after older relatives themselves; whilst many health professionals, in particular, see it as synonymous with self-management of long term conditions.
Although the Self Care Forum has long accepted that a single definition of self-care is problematic, and has created the now familiar continuum model, this is still subject to confusion and disagreement among professionals.
Personally I believe that effective population wide self-care should be the focus for good national public health planning, and that self-care should be defined in this context.
Fundamentally, effective planning for self-care should concentrate on giving everyone, from the earliest possible age, an appropriate working knowledge and understanding of their own bodies, and how to keep these healthy; and the capability to help others to do the same, particularly children and older people.
This requires effective health education throughout life, and the development of appropriate life-style attitudes and behaviours, combined with a sense of responsibility for how people conduct their own lives and contribute to those of others.
Essentially this requires everyone to have the wherewithal and willingness to deal initially with their own and others’ everyday health problems, and to know when, and to whom to turn to, if this is not possible or desirable. This demands personal up-to-date knowledge of national health structures, and good functional health literacy.
Effective public health requires both education and persuasion in matters around health protection (such as utilising vaccination programmes); disease prevention (particularly good hygiene); and body maintenance (through healthy lifestyles and regular health checks).
In order to achieve this the starting point must be with young people. It needs to include well planned and delivered health education in the appropriate settings – especially schools and clubs – by well trained and experienced teachers and youth workers. There is also well-evidenced scope for family and peer education through accredited health champions, and specialist support on specific health topics from appropriate health charities.
It is essential that these education programmes are fully supported by local health professionals including GPs, pharmacists and specialist nurses, who ideally should be working in schools and clubs with young people, as well as delivering programmes around self-care and health literacy in their everyday contact with patients.
Self-care is a lifelong process of skill and knowledge development, and it is important therefore that every opportunity is taken to supplement and update people’s health literacy through workplace and leisure time activities.
The Internet and social media are also useful resources, but these often fail to bring about changes in behaviour and attitude without more human interaction. There are also dangers of developing ‘healthipedia’ traits (Hodge SJ, Perspectives in Public Health, Vol 131 No 2, March 2011), when people seek to over-diagnose their own symptoms without having the necessary background understanding or experience, often leading to increased anxiety and potential mistakes.
As people age, formal education opportunities often become less attractive or accessible, and it is important for public health organisations to plan local outreach opportunities. For instance working with pre- and post-natal groups of parents, to increase awareness of wider health and wellbeing issues in the context of self-care around birth and early years, and the support available for this to be maintained.
Improved levels of population health literacy could be achieved through Public Health England and OFSTED monitoring this component in education and health settings. Publishing regular reports of observed good practice, and targeting those areas where there is noticeable underachievement, would be highly effective.
During this year’s Self Care Week, there will be many opportunities for health professionals and others to emphasise that real progress will be achieved, only when the key issues discussed in this paper become embedded within a national strategy of planned change, involving all those who have a part to play in protecting and improving public health.