What is the interplay between self-care confidence, professional support and health literacy among UK adults? A cross-sectional online survey study
File(s)
Accepted version
Author(s)
Smith, Peter
Altalib, Sami
Al Ammouri, Mahmoud
El-Osta, Austen
Type
Journal Article
Abstract
Background
The World Health Organization (WHO) defines self-care as "the ability of individuals, families and communities to promote health, prevent disease, maintain health and
cope with illness and disability with or without the support of a healthcare provider". while, self-care confidence refers to an individual's perceived ability to effectively engage in these activities. The interface between health and care professionals (HCPs) and the public is pivotal in promoting self-care behaviours, yet barriers such as health literacy deficits, professional constraints, misconceptions and disparities in
self-care confidence persist.
Objective
This study aimed to explore how self-care confidence, professional support and health literacy interact to influence self-care behaviours among UK adults.
Design
Cross-sectional online survey.
Setting
Community-based, national study of adults across primary care and community care
settings in the United Kingdom.
Participants
Community-dwelling UK adults aged 18 years and above, including health and care professionals, were recruited from June to September 2024 via social media, online research participant recruitment platforms and professional networks. Participants provided demographic information including age, gender, ethnicity, employment, education, disability status and UK region. Data collected from adults aged ≥ 18
residing in the UK able to complete an online questionnaire in English were included. Incomplete survey responses or duplicate entries were excluded.
Interventions
None (observational study).
Primary and Secondary Outcome Measures
Primary outcome: self-reported confidence in maintaining a healthy lifestyle and
managing common illnesses.
Secondary outcomes: accessibility to health information, health literacy (measured using the validated WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL) instrument, HLS19-Q12), self-reported knowledge of NHS guidelines and receipt of professional encouragement to self-care.
Results
A total of 3,255 community-dwelling UK adults (members of the general public) participated in the study. A subset of 227 participants self-identified as HCPs. Most respondents (88.5%) reported confidence in maintaining a healthy lifestyle; only 62.0% felt confident managing common illnesses. Locating professional help when ill was perceived as easy (77.4%) but not evaluating treatment options (51.4%) or mental health information accessibility (43.6%). Among HCPs, 94.7%endorsed the importance of self-care but cited patient reluctance to engage or take responsibility
(64.8%), understanding (59.0%), time constraints (42.7%) and health literacy challenges (45.8%) as key barriers. In the general population, 68.6% found screening
information accessible but 28.1% struggled with interpretation. Regression analyses revealed that older adults (65+) were significantly less confident in self-care with professional guidance (aOR=0.50 (0.33 - 0.74), p=0.001), whereas males (aOR=1.41 (1.23-1.62), p<0.001) and Black/Asian British individuals (aORs=2.31 (1.66-3.21), 1.98 (1.51-2.61); p<0.001) reported higher confidence levels.
Conclusion
This study highlights the complex relationship between professional guidance, self-care confidence and health literacy. While most individuals value and engage in self
care, critical disparities persist, particularly in health literacy and access to digital resources. Targeted interventions and strengthening the public-healthcare
professional dialogue and interface will be crucial in advancing self-care as a sustainable pillar of healthcare policy and practice.
The World Health Organization (WHO) defines self-care as "the ability of individuals, families and communities to promote health, prevent disease, maintain health and
cope with illness and disability with or without the support of a healthcare provider". while, self-care confidence refers to an individual's perceived ability to effectively engage in these activities. The interface between health and care professionals (HCPs) and the public is pivotal in promoting self-care behaviours, yet barriers such as health literacy deficits, professional constraints, misconceptions and disparities in
self-care confidence persist.
Objective
This study aimed to explore how self-care confidence, professional support and health literacy interact to influence self-care behaviours among UK adults.
Design
Cross-sectional online survey.
Setting
Community-based, national study of adults across primary care and community care
settings in the United Kingdom.
Participants
Community-dwelling UK adults aged 18 years and above, including health and care professionals, were recruited from June to September 2024 via social media, online research participant recruitment platforms and professional networks. Participants provided demographic information including age, gender, ethnicity, employment, education, disability status and UK region. Data collected from adults aged ≥ 18
residing in the UK able to complete an online questionnaire in English were included. Incomplete survey responses or duplicate entries were excluded.
Interventions
None (observational study).
Primary and Secondary Outcome Measures
Primary outcome: self-reported confidence in maintaining a healthy lifestyle and
managing common illnesses.
Secondary outcomes: accessibility to health information, health literacy (measured using the validated WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL) instrument, HLS19-Q12), self-reported knowledge of NHS guidelines and receipt of professional encouragement to self-care.
Results
A total of 3,255 community-dwelling UK adults (members of the general public) participated in the study. A subset of 227 participants self-identified as HCPs. Most respondents (88.5%) reported confidence in maintaining a healthy lifestyle; only 62.0% felt confident managing common illnesses. Locating professional help when ill was perceived as easy (77.4%) but not evaluating treatment options (51.4%) or mental health information accessibility (43.6%). Among HCPs, 94.7%endorsed the importance of self-care but cited patient reluctance to engage or take responsibility
(64.8%), understanding (59.0%), time constraints (42.7%) and health literacy challenges (45.8%) as key barriers. In the general population, 68.6% found screening
information accessible but 28.1% struggled with interpretation. Regression analyses revealed that older adults (65+) were significantly less confident in self-care with professional guidance (aOR=0.50 (0.33 - 0.74), p=0.001), whereas males (aOR=1.41 (1.23-1.62), p<0.001) and Black/Asian British individuals (aORs=2.31 (1.66-3.21), 1.98 (1.51-2.61); p<0.001) reported higher confidence levels.
Conclusion
This study highlights the complex relationship between professional guidance, self-care confidence and health literacy. While most individuals value and engage in self
care, critical disparities persist, particularly in health literacy and access to digital resources. Targeted interventions and strengthening the public-healthcare
professional dialogue and interface will be crucial in advancing self-care as a sustainable pillar of healthcare policy and practice.
Date Acceptance
2026-04-15
Citation
BMJ Open
ISSN
2044-6055
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Open
Copyright Statement
Copyright This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
License URL
Publication Status
Accepted