Noirin O’Neill wrote a blog for us, published on March 29th, titled “Self care, public health messaging and moral responsibilities during a global health emergency – a patient perspective”.  This was followed by a twitter chat on 8 April 2020.  The following is a summary of the main discussions that took place during the chat.  Thank you to all who participated. Due to the coronavirus pandemic our twitter chats are suspended until October 2020.

Self-care as a moral responsibility?

Participants in the Twitter Chat suggested that self-care is a moral responsibility. It means
different things to different people. Self-care can relate to physical, mental, spiritual and
emotional health. It was suggested that in a world where people can’t control many things,
they can still control how they look after themselves. Yet, there are many complex issues
that affect the ability of patients to self-care such as education, poverty, health literacy issues,
complex or rare conditions and lack of motivation.

It was acknowledged that a vicious circle exists which means that inequalities lead to an
increased chance of poor living conditions and lifestyle choices which can lead to ill health
and further inequalities. One participant suggested that self-care is a luxury and the
challenge for public health is to make self-care a community-wide concept which is
accessible, affordable, doable and uncomplicated.

Self-care during a global health emergency

Participants suggested that self-care is always a moral responsibility but during a
global health emergency, people think a little more about this and why it is important. When
resources are scare, self-care will help prevent illness or injury. We have seen a choice of
ways to engage online with healthy habits which makes self-care more accessible than ever
during COVID19 e.g. Joe Wicks’ daily PE classes for children on YouTube. For many,
staying at home is the legally “right” thing to do, is morally right but also medically correct and safe to do so.

Individual Health Messaging

Health messages do not always work when they are directed at the person directly in relation to their own health. Interestingly, one participant opined that addiction to drugs, gambling and smoking is related to the brain’s reward centre. It was suggested that the health belief model tells us a lot about individual health messaging. It depends how realistic a threat is perceived to be and we can easily position ourselves outside the target group. Participants agreed about the power of storytelling and suggested that we need more stories rather than facts.

Moral responsibility v personal responsibility

One view was that it is morally right to take care of yourself and that it is a moral obligation. and that public health messages should focus on moral responsibility e.g. self-protection from harmful UV rays. Yet, it was agreed that overall, the moral argument may not be persuasive for all.

A number of suggestions were made for alternative solutions such as (i) self-care should be pitched as a “personal responsibility” rather than a moral one and (ii) calling it something other than “moral” would help as “moral” is a loaded term and has a judgemental tone (iii) personal & public good’ might be better than ‘moral duty’ which may encourage rebellious behaviour.

It was noted that there are lots of people out there resisting current public health messages because of resistance to orders. This was evidenced in terms of people disregarding travel restrictions over the Easter weekend. It was suggested by one participant that unfortunately because of the actions of a small but notable section of society, legislative processes had to be put in place.

However, it was acknowledged that the message may not be getting through to some individuals who are living for the moment, partying, sunbathing and going out and about. Ultimately, whatever language is used, it depends on the health literacy of individuals as not everyone may understand the messages.

Messaging Strategies

Some tips for healthcare messaging included (i) simplicity matters (ii) consistent clear messages (iii) reduce cognitive load (iv) avoid an infodemic (v) give people tools to self-educate (vi) stamp out fake news.

It was agreed that multi-level messages that resonate on moral, ethical, societal, health and civic duties are needed.

Closing Thoughts

Self- care strategies and health message for the future may change. People now realise that self- care is not secondary to our busy lives. Self -care means self -education, self- empowerment, self- encouragement and self- reliance. We need to break down behavioural barriers.
Participants reflected on the difference between self-care as an individual and self-care as a community. We should all have the intent of a healthy society. One participant highlighted that there have been some incredible examples of compassionate communities and grassroots neighbourhood activism during COVID19. If we focus on how we can help each other as a family, as a community, as a village, as a town, as a city, as a country we are stronger together. We are all trying to protect each other. That is the message. We are seeing those bonds now during COVID19.