What do we want to know?
Minor ailments 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).
For example, in the UK, self-care ranges from consultation with friends, associates and family, internet searching/ digital applications and the purchase of over the counter medicines to minor ailment advice in community pharmacies, walk in/urgent care centres, NHS111 and support from non-GP and non-A&E healthcare professionals.
The broad aim of this review, is to explore the factors that may enhance, or limit, the effectiveness of interventions or services designed to promote self-care for minor ailments and to synthesise evaluations of existing interventions/services to estimate their effectiveness.
Four reviews were conducted. Review 1 synthesised interview studies that explored service-users attitudes towards and experiences of self-care for minor ailments. Review 2 also explored service-users’ attitudes towards, and experiences of, self-care for minor ailments but examined quantitative survey data. Review 3 synthesised the effectiveness of behavioural interventions or services for minor ailments. All these reviews are brought together in an overarching synthesis (Review 4) to explore contradictions and gaps between the reviews.
Who wants to know?
This project was commissioned by the Department of Health in England, and will be of interest to a range of stakeholders involved in the self-care of minor ailments including GPs, community pharmacists and other public health practitioners; researchers; health research commissioners and funders; and policymakers and regulators.
What did we find?
We found 58 studies conducted in the UK including evidence from 20 interviews, 13 surveys and 26 interventions.
Interviews (review 1) and surveys (review 2) led to the identification of multiple influences on self-care behaviour including:
- Lack of knowledge/skills about available self-care services and management of minor symptoms.
- Failure to consider alternatives to GP and A&E care.
- Anxiety that minor symptoms are due to some serious perceived health threat
- Provision of antibiotics in the past when they are not needed (thereby strengthening the connection between antibiotics and minor symptoms).
- Beliefs that the perceived severity of symptoms and susceptibility to illness posed a serious health threat with children being seen as especially vulnerable.
- Lack of appropriate social support from peers or relatives.
- Resource barriers 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)
- Flagging to people when their care seeking is inappropriate helped them to learn when it is appropriate to self-care.
Six intervention types were identified (review 3): education, NHS walk-in, telephone triage, practice nursing, GP antibiotic prescribing, and advanced paramedic roles. Of these, only one approach was shown to reduce GP attendances. There was also some evidence to suggest that advanced paramedic roles are effective in reducing A&E attendances among older people, though this intervention was evaluated in one study only. The overarching synthesis (review 4) showed that with exception of knowledge/skills and inappropriate prescribing of antibiotics the influences identified as important to self-care (reviews 1 and 2) were not directly targeted in intervention studies (review 3). 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.
What are the conclusions?
The review findings suggest the following implications for policy and practice.
- Interventions should target a multitude of potentially modifiable influences that underpin decision-making for self-care; educational interventions on their own are unlikely to beeffective.
- The range of salient influences on self-care (indentified in the interviews and surveys) suggest a need to consider co-ordinated approach to intervention that span the individual, social and environmental aspects of care-seeking behaviours.
- The issuing of back-up (delayed) antibiotic prescriptions for minor conditions should continue to be supported
- A range of interventions, that target the salient precursors to self-care could be implemented and tested for effectiveness in practice.
How did we get these results?
We searched 17 electronic databases supplemented with backward (searching the references of included articles) and forward (searching articles citing included articles, using Web of Knowledge) searches of the included articles and search of topic-relevant websites. Papers on self-care of minor ailments in the UK published from 2000 onwards were included. Three systematic reviews, and an overarching synthesis were conducted. The Behaviour change wheel (Michie et al. 2005, Michie et al. 2011) including the Theoretical Domains Framework (TDF) and COM-B model were utilised to provide a systematic, comprehensive, and theory-based method to identify barriers to self-care and potential strategies to overcome them. Reviews 1 and 2 synthesised interview (review 1) and survey (review 2) studies that explored service-users attitudes towards and experiences of self-care for minor ailments and used the TDF to characterise their potential theoretical mechanisms of action. Review 3 synthesised the effectiveness of behavioural interventions or services for minor ailments narratively. These three reviews were brought together in an overarching synthesis using the BCW to explore similarities, contradictions and gaps and to suggest possible approaches to intervention.
These reports should be cited as:
Richardson M, Khouja C, Sutcliffe K, Hinds K, Brunton G, Stansfield C, Thomas J (2018). Self-care for minor ailments: systematic reviews of qualitative and quantitative research. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London.