The Explore-Offer-Explore Approach
One of the effective ways for helping the patients overcome the barriers is the process often referred in evidence-based papers as “informing”. Healthcare professionals can use the “explore-offer-explore” approach and thereby ask the patient what he knows. Firstly, one important question that needs to be asked to the patient is “what would you first like to know or talk about?” This might help n inviting the patient in sharing what he feels important to know about his own condition from his own perspective. Many of the researchers are of the opinion that this question should be always accompanied with another question like “what do you already know or have idea about?”. This question needs to be coupled, as this would help the professionals as well as the patients in not wasting time about the information that is already known to them (Pugh et al. 2018). However, the practitioners should always provide information only after the patients provide permission. One thing that the professionals providing self management education to the patient should keep in mind that the they should share information in a neutral as well as judgmental manner and should be empathetic and compassionate in the approach. This would make the patient feel that the professionals understand the barriers genuinely that they are facing while trying to self-care for themselves. The professional in this approach should include experiences of the other patients with similar issues and barriers along with evidence based information about the target behavior (May 2016). The professionals should try to evaluate what the patients thinks and feels with the information with questions like “what do you think about this information, would it be helpful?”. Ultimately, the patient would be summarized about the approaches of the changing behaviors and thereby ask the patients to acknowledge about the feelings.
One of the interesting approaches that can be also adopted by the healthcare professionals for eliciting the individual belief of the patients about the particular health condition is the common-sense model. The assumption of the model is that every patient has the capability of natural self-regulation of their own behaviors and they are always motivated for avoiding any form of adverse effects of the illness, based on their beliefs about a particular condition. Researchers are of the opinion that dimensions of the illness beliefs are seen to include the presence of various specific symptoms as well as the diagnostic labels, the timelines as well as duration, the beliefs about the cause, the timeline or duration, the consequences (inconsequential too fatal) as well as the control and curability (Narva, Norton & Boulware 2017). These beliefs are mainly seen to determine the actions that an individual will take and how they will evaluate the effectiveness of the actions. Many of the researchers are of the opinion after following the common sense model that people with chronic ailments like that of renal disorders, they often fix themselves an “acute timeline” believing that once they feel better, their situation had developed and that they no more need to self care and thus discontinue the care. This model is helpful in assessing the cultural beliefs of the patients helping in these comprehensive understanding of the beliefs of the patient and behaviors about the health condition.
The Common-Sense Model
Self-efficacy can be defined as the individual patient’s confidence in his or her ability in taking effective actions as well as in persisting in the specific action despite of the challenges as well as obstacles and different challenges. Researchers are of the opinion that with the evolution of the perception of the self-efficacy, they are seen to become more experienced as well as knowledgeable. This shift in the perception has the ability of influencing the likelihood of the given behavior of the patient being adopted. Different studies have helped in revealing four main sources that can help the patients in developing their self-efficacy. These are the vicarious experiences of the patients developed through watching the behaviors of the others as well as mastery experiences (Villaire et al. 2017). Other two are the verbal persuasion from another significant individual as well as the physiologic feedback provided by the patient’s own physiologic state. Therefore, it can be stated that when patients can successfully initiate and practice the self-management of different tasks with the utilization of their self-efficacy sources, they can gain greater sense of control over their chronic kidney disorder.
One of the interesting strategies that had been developed is the peer support system. This strategy is one of the most innovative support system that the healthcare professionals are resorting. This would be helping the patients who are facing barriers in self-care management in the chronic kidney disorders. Researchers are of the opinion that the people who are having the chronic kidney disorder can help by sharing the knowledge as well as experiences with others in a procedures that many healthcare professionals cannot (Mamykina et al. 2015). Peer support can take many different types of forms that might include the phone calls, group meetings, text messaging, home visits as well as face-to-face visits. It is indeed seen that different types of peer support help in complementing as well as enhancing the other healthcare services. This can be dine mainly by creation of the emotional, social as well as practical assessment that help in management of the condition over time and staying healthy. Different peer supporters can be the paid health promoters, volunteers of the communities, other patients with same chronic conditions and many others.
Another very interesting strategy that can be discussed in terms of helping the patients in overcoming the barrier in self-care procedures of the chronic kidney disorders is the Collaborative goal setting. Collaborative goal setting can be defined as the exercise that can help in the development of the concrete, realistic objectives and goals for the individual patients. Researchers have noticed that the concept of setting goals helps in increasing the determination as well as self-efficacy of the patients helping the patient to become an active participant in the treatment plans (Zwar et al. 2017). It is however, true that in order for effective goals setting, the patients need to have confidence about their performance in self-management tasks and should believe that the goals would help them in bringing out positive health outcomes.
Self-Efficacy Sources
One of the most common psychological interventions that are not only used for chronic kidney disorder but also in other disorders like obesity, diabetes and many others are the cognitive behavioral therapy. Often many barriers have been put forward in the discussion with the patients where it was seen that many of the patients are failing miserably in changing their behaviors and these are affecting their self-management procedures of the symptoms of chronic kidney disorders. This therapy, which was previously used only in the treatment of depression and anxiety, are often used by present day professionals in helping patients change their behaviors in chronic disorder cases (Song et al. 2016). This therapy is a short term, goal oriented psychological approach that helps by taking a hands-on practical approach contributing in problem solving. This therapy would help in changing the patterns of the thinking and behaviors that cause various kinds of difficulties and help in changing the ways the patients feel. These would help the patients to change their behaviors and modify them in a way by which they can align themselves with their advised guidelines by the professionals and take part in effective self-care management.
From the discussion conducted with the patients suffering from chronic kidney disorder, different types of barriers that they face while self-caring for themselves have come up. The different types of barriers that were found were the physical barriers where the different signs and symptoms of the disorder make them tired, fatigued, stressed and distressed. Psychological barriers like that of depression, fear, anxiety and many others are also seen to occur among patients with chronic kidney disorders and these act as barriers to them in their self-care management (Lenzen et al. 2017). Besides, cognitive issues like lack of proper reasoning skills, thinking abilities, critical decision-making skills and lack of health literacy also act as barriers in self-caring of the patient. Often socio-economic barriers like lack resources and funding might create many barriers to the patient in self-care management. Other barriers that are also observed re the socio-cultural barriers where the patients are not seen to get enough support from fernds, family members, relatives and society and even lack of motivation and support are seen to be acting as barriers for them. Therefore, certain strategies need to be taken.
It is identified from the discussion sessions that although clients may need information as well as support for self-management about their healthcare conditions, they are the main individuals who are in complete control of their self-management decisions (Elton et al. 2015). It is true that different types of strategies are indeed present but the need of the client for support with decision making specific to the self-care management is often variable and therefore, it needs to be individually tailored. Therefore, depending upon the barriers that each of the patients is facing, the professionals can accordingly apply strategies to help them overcome the barriers.
Peer Support System
One of the most important strategies that can be applied is called the cognitive behavioral therapy. This is indeed helpful in altering the negative behaviors of the patients and help in modifying them in such a way so that they can align with the goals and objectives of taking effective self-care initiatives of their health. This psychological therapy focuses on talking with the consideration and modification of the ways by which the thoughts, beliefs and attitudes of the patients are seen to affect their feelings as well as behaviors (Beto et al. 2016). Thereby, this procedure will help the patients in modifying their behaviors. The patients become more successful in caring about themselves, become more focused and thus they develop coping skills. This would help in dealing with the barriers and taking effective self-care steps. This would be helpful for people who suffer from psychological barriers in self-care management (Boehmer et al. 2016).
As found previously, the patients are also seen to suffer from various lack of social support from the family members, friends and others in the society and hence they cannot always management their self-care effectively. In such situation, per support services are found to be most effective. Different types of per support services like that of the patients having the same chronic disorder, paid health promoters, volunteers of the community and similar other people can share their experiences as well as knowledge in a much different ways than the healthcare workers and these are often found to be fruitful (Lavoie et al. 2017). Even sometimes, such peer supporters are seen to receive effective training for providing education as well as emotional support, appraisal support as well as problem solving. Four important functions are seen to be provided by them which are the assistance with daily self-management, social as well as emotional support, develop a link to the clinical care and also provide ongoing support. This is helpful in overcoming socio-cultural barriers as well as physical barriers in self-care management.
In case of people with lower cognitive ability as well as low health literacy, professionals should try to follow the self-efficacy model. This approach would be helpful in the increasing of the confidence in the ability of the patients in taking action and thereby persisting to the action even if different types of obstacles arise. Researchers are of the opinion that more the patients become knowledgeable from their experiences as well as the health education that the professionals provide, their perception of self-efficacy evolve and this have positive impacts in their health (Hseigh et al. 2017). The professionals can follow audiovisual methods like short films, videos, power points as well as other similar procedures for educating them and helping them to develop self-efficacy and can undertake self-care strategies. The healthcare professionals need to participate along with the patients in the collaborative goal setting. This will help in the development of the concrete as well as the realistic goals for the patients. Many of the researchers support this, as they believe that the process of having a patient set goals automatically helps in the increasing of the self-efficacy helping the patient to become an active participant in the treatment plan (Geer and Boulware 2015). Therefore, professionals should try their best to incorporate self-efficacy development interventions to help patients overcome lack of cognitive as well as health literacy issues.
Collaborative Goal Setting
From the above discussion, it becomes clear that the patients with chronic kidney disorders often face different types of barriers in undertaking self-care initiatives. Peer support services, cognitive behavioral therapy, self efficacy development, explore-offer-explore” approach in motivational interviewing procedures and many others can help the patients in overcoming such barriers and live better quality lives.
References:
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Lavoie, K.L., Rash, J.A. and Campbell, T.S., 2017. Changing provider behavior in the context of chronic disease management: focus on clinical inertia. Annual review of pharmacology and toxicology, 57, pp.263-283.
Lenzen, S.A., Daniëls, R., van Bokhoven, M.A., van der Weijden, T. and Beurskens, A., 2017. Disentangling self-management goal setting and action planning: A scoping review. PloS one, 12(11), p.e0188822.
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Song, M.K., Ward, S.E., Hladik, G.A., Bridgman, J.C. and Gilet, C.A., 2016. Depressive symptom severity, contributing factors, and self?management among chronic dialysis patients. Hemodialysis International, 20(2), pp.286-292.
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