In the academic literature, there are a number of models from a variety of disciplines that describe factors that lead to health behaviours such as self-care. Psychological models distinguish between motivation for the behaviour and its implementation. One of the most widely used models is the Transtheoretical Model of Behaviour Change, which states that individuals change behaviour by progressing through a series of stages:

  • Precontemplation: when there is no intention to change behaviour;
  • Contemplation: when the person is aware of the need to ‘do something’ and is seriously thinking about it;
  • Preparation: when small steps are made towards the overall change;
  • Action: when behaviour is modified or participation in activity begins;
  • Maintenance: when the change is secured and the activity or behaviour becomes routine.

Progress is considered made if an individual progresses from one stage to the next, whilst slipping back a stage is considered a relapse.

Within the context of older people with frailty, the focus for supported self-care may start at the maintenance stage and be concerned with avoiding relapse (either through a loss of ability or willingness to act). Alternatively, it may be about making new changes in particular domains of frailty that will build resilience and thus help to reduce the impact of vulnerabilities arising elsewhere, particularly those which are due to circumstances beyond the individual’s control. There may be particular ‘trigger events’ that precipitate engagement with self-care, or the self-care intentions could have been developed through a longer period of contemplation.

The Practical Guide to Healthy Ageing begins by suggesting people self-conduct the four-metre walking speed test (taking longer than five seconds to walk four metres is highly indicative of frailty) on the basis that people are more likely to engage with the guide if they reason “it is for me” because they find they are walking slowly. This follows the principle of self-discovery and self-activation which can be considered as ‘triggers’ for moving from Precontemplation, through Contemplation and towards Preparation in the model outlined above.

Deciding “what I need to do” is an important aspect of supported self-care, but family, friends and healthcare professionals will have a big role to play in the discovery process.

This model can help us to think about the support that may be necessary or appropriate at any particular stage, which is set out in the toolkit as:

It is also important to understand the influences on an individual and their motivation to maintain an activity, regain or stop behaviour, or start something new. These will differ from individual to individual but can be considered holistically by using all of the six domains of frailty.