Minor ailments (MAs) have been defined as non-complicated medical conditions which can be self-diagnosed and managed, with or without the support of a healthcare professional. Some minor ailments, however, consume significant numbers of appointments with general practitioners (GPs) and attendances at accident and emergency (A&E) departments, which places an unnecessary strain on these overstretched services. People can often take care of their minor ailments themselves (such as a sore throat or cough) through for example, use of over-the-counter medicines and support from friends or family. Self-care services such as community pharmacy, walk-in/urgent care centres, and NHS111 can also provide support and reduce the burden on GP and A&E services. This project brought together findings from research about self-care of minor ailments. We found 58 studies conducted in the UK. Overall, these studies showed that whilst in general, people are willing to self-care for their minor ailments, this preference for self-care was compromised by seven key influences. These included: • Lack of knowledge/skills about available self-care services and management of minor symptoms. • Memory, attention and decision-making in the context of considering alternatives to GP and A&E care. • Anxiety (e.g., increased heart rate, sweating, trembling) that minor symptoms are due to some serious perceived health threat that warrants GP or A&E attention. Anxiety is more of an automatic and involuntary response compared to conscious beliefs about engaging in a behaviour (such as beliefs about perceived severity, below). • Reinforcement of unnecessary GP attendances by healthcare professionals (e.g. through provision of antibiotics when they are not needed, thereby strengthening the connection between minor symptoms and the need for antibiotics). Reinforcement that care-seeking was inappropriate also helped service users to learn when it is appropriate to self-care. • Beliefs that the perceived severity of symptoms and susceptibility to illness posed a serious health threat that warranted GP or A&E attention with children being seen as especially vulnerable. • Lack of social support from peers or relatives. However, in some cases, social support was shown to legitimise inappropriate GP attendances (e.g. through encouraging GP visits). • Environmental context and resources issues relating to access (e.g. time to access care) cost of over-the-counter medications, and limited professional roles (such as inability to prescribe or physically examine patients) were also shown to prevent self-care for minor ailments. Existing interventions target a lack of knowledge and delayed antibiotics prescribing (e.g. issuing back-up prescriptions) with only the latter showing beneficial effects in terms of reducing the number of GP attendances. This is unsurprising, as education interventions on their own are often insufficient, especially when the behaviour is influenced by a range of factors as is the case for self-care. Surprisingly, the other influences identified as important to self-care were not directly evaluated in intervention studies. We therefore suggest a range of interventions based on the key influences of self-care that could be implemented and tested for effectiveness in practice. For example, persuade service-users from being overwhelmed by anxiety (such as enabling service-users to identify anxiety triggers that drive the urge to attend GP/A&E and develop strategies for managing them). See table 0.1 (executive summary) for a complete list of suggested strategies. Whilst the involvement of key stakeholders helped to ensure the relevance of these findings for the UK policy context, many of the studies examined were not optimally designed or conducted; therefore, our conclusions must be considered cautiously. Further research is needed before we can be clear about the relative importance of each influence on the self-care of minor ailments.
|Place of Publication
|EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London.
|Department of Health and Social Care
|Number of pages
|Published - Jun 2018