Healthwatch Dudley research shows that self-care is a complex topic and what it is can be different depending, for example, on where you live, whether you have a job or not, and how old you are. We undertook work to gather people’s views on self-care to get a better understanding of what it is and how it might be supported. At the same time, we wanted to know more about how the different circumstances that people find themselves in might determine how they are able (or not) to look after themselves, stay well and get access to the care they need when they are unwell.
Choosing self-care for life
NHS England has, for some time now, been encouraging us all to choose self-care for life and suggesting how they can look after their own and their family’s physical and mental health. In turn, it wants more people to be involved in ‘Taking action for both themselves and others whilst understanding how to use health services’. But, self-care can be thought about and described in different ways.
It can be about people, events and actions located on a self-care continuum. At one end is the responsible individual making daily choices about lifestyle, health and the management of any conditions they have. At the other end there are events like compulsory psychiatric care and treatment for major trauma or illness that is administered by professionals responsible for what happens to an individual (see Figure 1).
Meanwhile, there are the wider determinants of health and wellbeing – such as where we live, the jobs we have, and how we are able to get access to good quality housing and health care services. We need to understand how the circumstances that we find ourselves in can affect our capacity to self-care (see Figure 2).
It is widely acknowledged that our opportunity for good health starts long before we need health care. And consequently, our unhealthy behaviours are most often ‘Usually not the origins of poor health but the end point of a long chain of causes and consequences in our lives’. There is a strong case for thinking that responsibility for health should extend beyond the individual and the health and social care system to include the whole of society.
‘We know what we should do, but we don’t always do it’
Self-care is about understanding yourself and others understanding you. However, it was remarked that ‘A lot of people want to self-care, but they can’t do it without support’. And bureaucracy and red-tape gets in the way and stops communities and individuals from taking action to do things at the local level through self-help, leisure and other social activities.
Time and effort must be given to making the most of what exists in communities already, the buildings, facilities and group activities and individuals and their knowledge, skills and talents.
At the same time, people want help and advice from well-qualified professionals who can provide them with information, where it is appropriate, on how they can best look after themselves when they feel unwell. In turn, relations work better when there are good communications that ‘Instill confidence that something can be done’, whether it is through a conversation to get advice on what to do next, help with the management of an ongoing health condition, or information on care and treatment.
There is something about our health and wellbeing that is about having control and choice over what we do and what happens to us. And sometimes we just need to slow down, listen to our body and get through the day. Understanding that there will be days when you feel down and need to deal with knocks and setbacks. Then there are the times when you need people to be around who care about you and will listen to what you have to say. Maybe we need to reflect on what is happening in our lives and ‘Identify the positives, new opportunities, new hobbies, new experiences’.
The aim must be to give people real choice over what happens regarding their self-care. And reassure them that they will be able to get access to appropriate services and professional help when they need it.
Our health and capacity to self-care can depend a lot on being surrounded by people we love and trust and ‘Being connected with others and a community’. It can also be about ‘Finding time to look after yourself, doing things you want to do, outside of busy lives at work’ and being able to express your emotions and laugh.
Policymakers and other professionals, with an interest in self-care, need to work with people, from a wide variety of backgrounds, to learn more about what it means to them and how they might be supported to do it better. We need to know what hinders or stops people from undertaking self-care activities. It might be because they are living in poor or insecure accommodation, are struggling to live on a low income, or have no family or friends nearby to offer help and support. On professionals it was remarked that ‘They should come to our natural environment’ and work with people to find out what their health and wellbeing needs are and what can be done together to promote and sustain good self-care activities.
How to promote and support self-care
Have in-depth conversations with people from all types of background to get a diversity of views on self-care and wellbeing.
Develop strong relations with communities, be inquisitive, and adopt a non-judgmental approach to understanding lifestyles and aspirations.
Determine what opportunities exist for self-care and wellbeing quick wins targeting resources appropriately to achieve them.
Get the messages out on self-care, thinking about what it is and how to get help with it.
Get people involved and more in control of what happens in the area where they live and the design of services to meet jobs, environment, housing, leisure, transport, education and health needs.
Make the most of existing community strengths and bonds, buildings and facilities and people’s knowledge and skills in a place based approach to partnership working that celebrates the good things already happening in an area and identifies and deals with gaps in services and support for self-care.
Clearly identify how self-care and staying healthy, the prevention of illness, and getting access to treatment when it is needed are intimately bound together and can be part of a well thought through population and personal health and wellbeing pathways
Set out personal and collective community and organisation responsibilities for promoting, supporting and doing self-care so that it works for everyone
 NHS England (2018) ‘Encouraging people to choose self-care for life, https://www.england.nhs.uk/2018/11/encouraging-people-to-choose-self-care-for-life/
 Self Care Forum, http://www.selfcareforum.org/about-us/what-do-we-mean-by-self-care-and-why-is-good-for-people/
 Dahlgren G, Whitehead M. (1991) ‘Policies and Strategies to Promote Social Equity in Health’, Stockholm, Sweden: Institute for Futures Studies, https://ideas.repec.org/p/hhs/ifswps/2007_014.html
 Lovell, N. and Bibby, J. (2018) ‘What makes us healthy? An introduction to the social determinants of health’, The Health Foundation, https://www.health.org.uk/publications/what-makes-us-healthy
 NHS England (2014) ‘The Five Year Forward View’, https://www.england.nhs.uk/five-year-forward-view/
 Department of Health and Social Care, ‘Prevention is better than cure: Our vision to help you live well for longer, 2018. https://www.gov.uk/government/publications/prevention-is-better-than-cure-our-vision-to-help-you-live-well-for-longer
Find out more about Healthwatch Dudley’s work and research at www.healthwatchdudley.co.uk