Working definition
Our working definition for this guideline comes from a 2009 WHO regional working group in South-East Asia, whose definition for self-care in the context of primary health care has subsequently been cited many times in other WHO documents:
“Self-care is the ability of individuals, families and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a health-care provider” (1).
Self-care is broad concept which also encompasses hygiene (general and personal), nutrition (type and quality of food eaten), lifestyle (sporting activities, leisure, etc.); environmental factors (living conditions, social habits, etc.), socioeconomic factors (income level, cultural beliefs, etc.) and self-medication (2).
Other common definitions for self-care in WHO documents included: non-professional care, “unorganized health activities and health-related decision-making by individuals, families, neighbors, friends, colleagues at work” (3); “utilization of all non-health professional resources, i.e. the individual himself or herself, members of the family, neighbours and other lay persons, for any health-related activity be it promotive, preventative, curative or rehabilitative” (4); and “Self-care … is the primary health resource in the health care system. Included are informal health activities and health-related decision-making by individuals, families, neighbours, comprising self-medication, self-treatment, social support during illness, first aid, etc. Another term, ‘lay care’, describes all health care given by lay people to one another in both natural and organized settings” (5).
Key aspects of self-care definitions
Relationship with health system: One primary characteristic of self-care definitions across WHO documents was the relationship between self-care and the health system. Some defined self-care as independent of, or in opposition to, the health system. Others defined self-care as collaborative with, or part of, the health system. For example, some definitions considered self-care part of primary health care, or the first level, a building block or a domain of the health system, or as part of a continuum of health care. Some definitions described self-care as supported by the health system (or vice versa). Many definitions emphasized that self-care was not a substitute for, but rather a complement of, the health system, pointing out the co-production of care. Self-care was also described as essential to and simultaneous with the health system – a co-occurring phenomenon.
Who and where: Most definitions of self-care mentioned specific agents for self-care, usually referring to non-health-care professionals. Some definitions focused on the individual (“self”), but others included family members and larger organizational or community structures. Self-care was typically located at home, i.e. care that can be practised at home or a household process. Some definitions placed self-care in a “natural setting”, i.e. the normal context of people’s everyday lives. Self-care definitions also described the role of the health system in various ways. In some cases, the health system was to provide education (e.g. information, technology, techniques) so that people could carry out self-care.
Others emphasized the need for linkage to or support from the health system, especially when describing self-care as part of a continuum.
Scope: Definitions of self-care could be generally categorized through two dichotomies. First, self-care could be defined in terms of habits or activities of daily living or lifestyle, or in terms of management of illness, medication(s) or disease episodes. Some definitions related self-care to coping, social support or emotional aspects of health management. Second, self-care could be defined in terms of the ability to do something (i.e. empowerment, decision-making) or in terms of the actual activities themselves (i.e. actions). In all cases, self-care carried an element of active engagement. Self-care meant that individuals were actively monitoring and responding to a changing environment. One WHO document defined self-care as an “active, responsive, and flexible process of self-management” (6). Individuals engaged in self-care were willing, capable, informed and ready to do something for their own health.
Core principles: Fundamental principles for self-care include aspects of the individual (e.g. self-reliance, empowerment, autonomy, personal responsibility, self-efficacy) as well as the greater community (e.g. community participation, community involvement, community empowerment).
