What is self-care?

Overview

A person undertakes self-care decisions and actions to address a health problem or to improve his or her health. Popular self-care therapies include relaxation, meditation, imagery, hypnosis, biofeedback, education, special diets, natural products, and nutrition supplements. In 2009, the National Center for Complementary and Alternative Medicine (NCCAM) (later renamed the National Center for Complementary and Integrative Health (NCCIH)) announced that Americans had spent an estimated $22 billion on self-care classes and materials over twelve months.

Mechanism of Action

It is difficult to evaluate the action of self-care therapy because in most situations, it is not feasible to use placebo controls. For example, in one of the better-documented modalities, the Arthritis Self-Management Program, retrospective analysis shows that pain reduction was maintained four years after therapy began and that physician visits decreased by 40 percent. The program used education, cognitive restructuring, relaxation, and physical activity, but it is impossible to show what treatment was responsible for what result; also, no control group was included for comparison.

Uses and Applications

Several health care trends favor the use of self-care therapies. Some persons see conventional health care becoming more effective but also unaffordable for many. Studies show that those who have delayed or skipped medical care for financial reasons are highly likely to try self-care, particularly self-medication.

At the other end of the spectrum are those who distrust mainstream health care and want instead a type of care that promotes empowerment and personal control. Another factor leading people to try self-care is having learned about and becoming comfortable with complementary and alternative medicine (CAM) therapies over time. In addition, CAM therapies that previously could be found only through nontraditional outlets are now widely available. Likely CAM users include the elderly, those who are well educated, and those with conditions such as severe depression and panic attacks. Studies also show that people between the ages of thirty-five and fifty years are part of a fast-growing group of CAM users.

Another study showed that twice as many people read self-help literature as see a CAM practitioner to learn relaxation techniques. This follows a general trend showing that the use of self-care therapies has increased at the same time that consultation with CAM providers has decreased. An analysis of persons on Medicare showed that the most frequently sought forms of CAM were those for back problems, chronic pain, general health improvement, and arthritis. Research has demonstrated the efficacy of relaxation, biofeedback therapy, cognitive strategies, and education in treating chronic pain conditions such as osteoarthritis, rheumatoid arthritis, and fibromyalgia. Persons using self-care engaged in health-affirming practices such as exercise, smoking reduction, and limiting alcohol consumption.

Scientific Evidence

Some of the studies used to measure self-care are flawed because the research questions depend on a person’s ability to report CAM use accurately or to remember his or her use of CAM. Typically, information is collected once, so there is no opportunity to study CAM use over time.

Flawed methodology can occur if researchers do not spell out distinctions between complementary and alternative therapies versus more radical alternatives. Peer-reviewed studies of self-care have shown improvements in cancer-related pain, headache pain, and cardiovascular disease as a result of relaxation techniques, behavior modification, imagery, hypnosis, stress management, and health education. Clinical trials showed, for example, a 43 percent reduction in headache activity, improvement of chemotherapy-related symptoms such as nausea and vomiting, and a 41 percent reduction in cardiac deaths.

One study looked at changes in health status longitudinally and found no difference in health status when researchers compared therapies such as chiropractic, massage, acupuncture, and herbs with conventional medicine. However, the results of CAM therapies in general, and of self-care specifically, may take longer to manifest. Researchers have called for controlled clinical trials, including large-scale surveys, and in-depth studies of specific populations.

Safety Issues

A lack of relevant scientific studies makes it difficult to determine the safety and efficacy of self-care. Herbal remedies may interact with prescription medicines in harmful ways, with both the person seeking care and the prescribing physician unaware of the risks. Scientific literature on interactions is scarce. Existing information may be skewed, because many people do not tell their physicians that they are using a self-care modality of CAM.

Bibliography

"Americans Spent $33.9 Billion Out-of-Pocket on Complementary and Alternative Medicine." National Center for Complementary and Integrative Health. Natl. Inst. of Health, 30 July 2009. Web. 27 Jan. 2016.

Astin, J. A., et al. “Complementary and Alternative Medicine Use Among Elderly Persons.” Journal of Gerontology: Medical Sciences 55A (2000): M4–M9. Print.

Astin, J. A., et al. “Mind-Body Medicine: State of the Science, Implications for Practice.” Journal of the American Board of Family Medicine 16 (2003): 131–47. Print.

Nahin, R. L., et al. “Costs of Complementary and Alternative Medicine (CAM) and Frequency of Visits to CAM Practitioners: United States, 2007.” National Health Statistics Reports 18 (2009): 1–15. Print.

Pagán, J. A., and M. V. Pauly. “Access to Conventional Medical Care and the Use of Complementary and Alternative Medicine.” Health Affairs 24 (2004): 255–62. Print.

Palinkas, L. A., and M. L. Kabongo. “The Use of Complementary and Alternative Medicine by Primary Care Patients.” Journal of Family Practice 49 (2000): 1121–30. Print.

Sparber, A., and J. C. Wootton. “Use of Alternative and Complementary Therapies for Psychiatric and Neurologic Diseases.” Journal of Alternative and Complementary Medicine 8 (2002): 93–96. Print.