Pregnant People - Key Activity 10

KEY ACTIVITY #10:

Support Patient Self-Care

This key activity involves the following elements of person-centered population-based care: proactive patient outreach and engagement; care coordination; behavioral health integration.

Overview

The term “self-care” refers to patients’ engagement in the activities and decisions that improve their health and well-being. Supporting self-care involves activities that enhance the capacity of individuals to engage in their care. Research demonstrates that pregnancy can be a particularly impactful time for patients to make positive changes with respect to self-care^[1].

Action steps and roles

1. Improve information resources for patients.

Suggested team member(s) responsible: If a patient and family advisory council is in place, ask them to develop and/or refine patient information materials along with clinic staff.

• Update patient information materials, translating to language prevalent in the community, and reviewed by patients and families where possible.
• Support patient use of a patient portal that links to reputable health information. Consider including links to respected websites and social media accounts.
• Be aware of each patient’s health literacy, their ability to use health information effectively. Ensure materials are written at appropriate literacy level.
• Discuss a patient’s interest in information about health topics during clinic visits and preferred ways to receive information. Rather than assuming a patient needs and wants certain information, use tips from the field on motivational interviewing to ask open-ended questions.

Tip: Self-care coaching can begin with new patients. Consider holding on-boarding group visits for new pregnant patients that orient the patients to the clinic, its workflows and resources, and opportunities for self-care support.

2. Identify opportunities to enhance patient knowledge and confidence.

Suggested team member(s) responsible: Clinic staff including social workers, educators, nurses and providers.

Enhance knowledge and emotional support through a support network of family, friends and doulas so that the patient feels empowered to fully utilize health resources, services and supports.

Birth plans can be a particularly impactful way to engage clients in their own prenatal and birth experiences. ACOG and the California Maternal Quality Care Collaborative have resources to share with clients regarding birth plans.

3. Implement shared care plans with patients.

Suggested team member(s) responsible: Care team, patients and family members, if appropriate.

Shared care plans (see AHRQ Shared Care Plans) involve decisions of how the patient/provider discussion will be fit into the clinic visit workflow; training in facilitating collaborative conversations with patients; what format a shared care plan will take (a pa vs. electronic copy to be shared at the end of any interaction); and how the shared care plan will be documented.

4. Address health-related social needs that impact self-care.

Suggested team member(s) responsible: Care team.

• Implement universal Social Needs Screening and use the results to identify health-related social needs of patients. See Activity 7: Use Social Needs Screening to Inform Patient Treatment Plans for more information.
• Update a directory of community-based resources (see Activity 18: Strengthen Community Partnerships for examples) and routinely refer patients to appropriate resources through the care coordination process already in place.
• Follow up with patients who have been referred to community-based resources to learn if the referral was helpful.
• Begin self-care coaching in the exam room. Consider opportunities to leverage the extended members of the care team who often are representative of the populations you are serving. The self-management coaching can occur before being seen by a clinician (while waiting for the provider) and after seeing the provider. The key is to ensure the self-management coaching is well coordinated by the integrated care team.
• Self-care coaching for people with behavioral health conditions: National Institute of Mental Health (NIMH): Caring for Your Mental Health.

5. Implement self-management support.

Suggested team member(s) responsible: Care team.

• Self-Management Support (SMS) is a technique that enables patients to play an active role in their healthcare. SMS uses the ask-tell-ask approach, patient-directed goal setting, and follow-up to support individuals in making decisions that benefit their health and well-being. Training for staff and providers will be necessary to implement SMS.
• Assessment of self-activation capacity of patients can help health centers identify system-level interventions that can build self-care capacity at a population level. For example, offering classes for specific populations or group visits.
• See technology considerations for guidance on using apps to support self-care for pregnant patients.

Evidence base for this activity

Dineen-Griffin S, Garcia-Cardenas V, Williams K, Benrimoj SI. Helping patients help themselves: A systematic review of self-management support strategies in primary healthcare practice. PLoS One. 2019 Aug 1;14(8):e0220116. doi: 10.1371/journal.pone.0220116. PMID: 31369582; PMCID: PMC6675068.

Hibbard JH, Greene J. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Aff (Millwood). 2013 Feb;32(2):207-14. doi: 10.1377/hlthaff.2012.1061. PMID: 23381511.

Roy D, Meador M, Sasu N, Whelihan K, Lewis JH. Are Community Health Center Patients Interested in Self-Measured Blood Pressure Monitoring (SMBP) – And Can They Do It? Integrated Blood Pressure Control [Internet]. 2021 Feb [cited 2021 Aug 8];Volume 14:19–29. Available from: https://dx.doi.org/10.2147%2FIBPC.S285007.

Action of Patients for Successful Self-Management, J Ambulatory Care Manage Vol. 32, No. 1, Simmons, L., et al, 2009.