The experience of self-care: a systematic review

Abstract

Background Self-care has been defined quite simply as "the set of activities in which one engages throughout life on a daily basis."1,p.68 Examining this 'set of activities' more closely, we see that a number of activities encompass "a person's attempts to promote optimal health, prevent illness, detect symptoms at an early date, and manage chronic illness."2,p.2 Hence, engaging in self-care activities may result in a range of different experiences depending on the set of activities that are performed and the reasons for their undertaking. Objectives To integrate and summarize the experience of engaging in self-care activities as reported by individuals and /or their families. Inclusion criteria Types of Studies - Qualitative studies included, but were not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. Types of Participants - Individuals and/or their families who engaged in self-care activities, or were assisted with their self-care activities, or provided support for self-care. Types of Interventions - Individual experiences of self-care in response to an intervention or where no intervention was introduced. Types of Outcomes - Individual experiences of self-care through self-report. Reports from family members who assisted or provided support for self-care were included. Search strategy The search strategy aimed to find both published and unpublished studies (e.g., theses). A three-step search strategy was used in each component of this review. An initial limited search of MEDLINE and CINAHL was undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all identified keywords and index terms was then undertaken across all included databases. Thirdly, the reference lists of all identified reports and articles were searched for additional studies. The databases searched included: CINAHL; MEDLINE; EMBASE; PsycINFO; AMED; Cochrane Library; Scirus; and Mednar Methodological quality Methodological quality of the studies was assessed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument Critical Appraisal Checklist for Interpretive & Critical Research. Two appraisers independently reviewed each study. Data collection and analysis Qualitative data were extracted from included studies using an adaptation of the standardized JBI Data Extraction Tool for Qualitative Evidence. Data synthesis The data were synthesized using narrative form. Results and conclusions Engaging in self-care is a process involving being aware of self, acquiring knowledge and taking responsibility for meeting needs at whatever level they are presented. The performance of self-care behaviours can be influenced both positively and negatively by the attitudes of others. Throughout life, the purpose for performing self-care differs and individuals face challenges that interfere with their ability to master these self-care behaviours. Individuals who are able to find symbolic meaning in the disease/disability or reframe the implications positively are more capable of adapting and maintaining their focus on caring for themselves. Studies revealed that individuals may abandon self-care when overwhelmed by symptoms or disability and/or when they feel that they are not supported. Implications for practice It is valuable for health care professionals to understand the struggle that individuals experience when trying to engage in self-care. Furthermore, health care professionals need to be cognizant of how important their support is, in terms of encouraging individuals to adopt and maintain self-care behaviours. Implications for research This review has provided an insight into the process of engaging in self-care through the different developmental stages of life, as well as the adoption of self-care behaviours to meet different requisites. Further research would be valuable to integrate the range of health care interventions provided to individuals across different disability or disease groupings who engage in self-care activities.