What Influences Enablement?

Contexts in which people seek to care for their health include:

• health service characteristics
• illness complexity
• life circumstances
• social circumstances

The Chronic Care Network’s social determinants of health provides more information about life and social circumstances that affect health

External, such as physical access or affordability of health services. Health systems and services can influence external determinants with policies and practices that support or provide:

• cultural safety
• translators
• transport assistance
• financial assistance
• extended hours
• outreach services
• way finding assistance

These are usually fixed or very difficult to change. It is usually better to work with these factors in building enablement than to try to change them.

• education
• language
• culture
• beliefs

Positive or negative interactions (known as feedback loops) with healthcare providers can influence a person’s ability to cope with and manage their health. These can occur on an emotional and a practical level and sometimes lead to rapid and significant changes to a person’s level of enablement.

Negative feedback loops can undermine someone’s confidence and ability when attempting activities that will enhance their health in the future. On the other hand, positive feedback loops can build their knowledge, confidence, trust and ability.

Healthcare providers can facilitate positive experiences, by using approaches designed to give people control over factors that improve health outcomes. For example:

• promoting organisational cultures where clinicians are well supported, have high job satisfaction, and deliver healthcare with compassion and empathy
• promoting informed decision making
• improving organisational health literacy
• tailoring communication to the individual
• providing cultural support
• wayfinding and care navigation services
• using patient reported experience measures.

Non-clinical experiences, such as interactions with peer groups, social groups, family members and carers, can also change a person’s motivation, confidence and ability to manage their health.

We can help people have better outcomes from these non-clinical interactions by:

• understanding their social and family situation
• encouraging them to establish peer support networks
• promoting health literacy at every opportunity
• providing education that incorporates self-management and empowerment
• helping people develop skills to find and understand reliable health information online and in their community
• using health coaching and motivational interviewing to increase people’s self-sufficiency, knowledge, confidence and motivation to manage their health.

Enablement is influenced by the context in which people manage their health. People need higher levels of personal knowledge, skills, energy and confidence to successfully manage their health when:

• they have multiple complex health problems
• their life is complicated by many conflicting priorities, demands and issues
• their social networks and social pressures present barriers
• their cultural and religious beliefs are assumed to be different to those in the community or health system
• health systems are fragmented, bureaucratic, technical and hard to navigate.

Components of enablement have a direct effect on people’s ability to care for their health and manage the impact of health issues in their lives. The boundaries between determinants and components is not always clear but the components of enablement always have direct functional influence on how well a person is able to manage their health.

Components of enablement can be grouped as follows:

1. Cognitive – understanding, knowledge, cognition and beliefs about treatment
2. Affective/motivational – psychological status, values, attitudes and self confidence
3. Physical – mobility, medication side effects, physical impairments and limitations
4. Relational – communication and support from providers, family and friends.

The importance of different components will vary with people’s circumstances and can be influenced by positive and negative experiences. Strengths in one category may compensate for weaknesses in another. For example, a person with limited knowledge about health issues who has difficulty acquiring knowledge and problem solving (cognitive components) may look after their health very well by following the advice of a trusted healthcare worker with the assistance of a supportive family (relational components).