Over the past 100 years the average life span of humans has increased in developed countries. Mortality rates have changed because of the virtual eradication of infectious diseases, such as polio and smallpox, and the increase in chronic diseases. Chronic diseases, such as coronary heart disease, are related to lifestyle behaviour, a factor over which the individual has some control. Matarazazo (1984) believes that 'behavioural pathogens are the key to understanding health behaviours of the individual and subsequently designing more effective methods of dealing with chronic disease and illness. Fries (1980) suggests another approach to dealing with chronic disease, through the strategy of 'compressed morbidity'. This refers to the postponement of chronic infirmity relative to average life duration. By achieving compressed morbidity, it is expected that health costs will decrease and improvement of quality of life will occur. This may be possible in at least two ways: firstly, by self-empowerment of the individual and secondly by the development of health self-efficacy. Thus giving the individual the power to act upon certain health-damaging behaviours as well as the confidence to influence behavioural change and persistence to cope with difficulties whilst the process of change is occurring. Thirdly, as a result of this, behaviour changes will occur and this would lead to a reduction in health cost which would be of overall benefit to the community. One method of reducing these health care costs is through health promotion and health education. Improvements in health knowledge and skills through health education and health promotion has been shown to facilitate changes in lifestyle and so reduce the incidence of various diseases. This study examined the effectiveness of two types of self-care models, health self-care and medical self-care. Health self-care refers to individuals assuming more responsibility for prevention, detection and the treatment of health problems using self-care information. Medical self-care involves the use of General Practitioners (GP) offering advice to their patients and subsequently patients making informed decisions about their health. The health self-care model Healthtrac, attempts to provide an effective use of the Australian health care system. Healthtrac is an information and skills based mail delivery program designed to assist individuals in elevating their perceptions of health self-efficacy and improve their lifestyle behaviours. Better Health is the medical self-care model which is designed with the perspective that GP's are the best suited as the initiators of change in individual health self-care. Participants (N = 864) are adult males and females. The methodology for this study involved 864 high risk of chronic disease participants who have been identified using the Healthtrac Health Risk Assessment (HRA) instrument. There were (n = 343) participants in the health self-care group, (n =66) in the medical self-care group and (n = 455) in the control group. This instrument was designed to identify individuals who have or are at high risk of developing chronic disease. These participants were part of the Better Health promotion program of a Health Insurance company. All the participants received a letter of advice detailing the presence of certain risk factors as determined by their health risk appraisal. They were requested to visit their local GP who recommended the necessary behavioural changes and medical support required for medically satisfactory outcomes. They were encouraged to follow the advice of the GP and received a second HRA after 6 months and again12 months after the start of the project. The Healthtrac component of the study involved 343 subjects who completed the HRA instrument. Participants in this group were matched with the Better Health subjects for variables such as age, gender, employment, disease or lifestyle and educational level. Baseline impact variables were calculated and compared with the same variables at 6 monthly intervals during the 12 month period of the study. Process variables such as user satisfaction were determined by a questionnaire. Investigation of the Health Benefits Organisation records were used to gather data on the number of claims for hospitalisation and other medical costs. A control group of 455 participants were matched with the same variables as those participants in the health self-care model and medical self-care groups. The analysis of results indicate that variables such as number of doctor's visits, days spent in hospital and total risks scores for the health self-care model were lower than the Medical model scores. The variable, cost of disease findings indicate that there were no significant differences between the two experimental groups, from the baseline data (Q1) to the 12 month period (Q3). The cost of diseases for heart disease was able to be lowered more by participants in the health self-care than the medical self-care model. The opposite occurred for the blood pressure condition. The health self-efficacy questionnaire results indicate that the health self-care group participants reported higher self-efficacy scores, therefore they were more confident about the self-management of their health behaviours than the members of the medical self-care group. No significant differences occurred among the experimental and control groups on such variables as achievement of outcomes and management of disease on self-efficacy scores. Both experimental groups, health self-care and the medical self-care model philosophies have strengths and weaknesses. Health self-care provides health information and support through printed materials whereas the medical self-care model provides health information through GP's. Both health promotion programs are important in making the individual aware of methods needed to improve health and in developing the knowledge necessary to modify clients health behaviours. This in turn is an important factor in the reduction of medical costs and the prevention of some diseases.
| Identifer | oai:union.ndltd.org:ADTP/265062 |
| Date | January 2004 |
| Creators | Dzenis, Haralds (Jack) |
| Publisher | Queensland University of Technology |
| Source Sets | Australiasian Digital Theses Program |
| Detected Language | English |
| Rights | Copyright Haralds (Jack) Dzenis |
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