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The effectiveness of self-care interventions in chronic illness : A meta-analysis of randomized controlled trials
Lee, Christopher Westland, Heleen Faulkner, Kenneth Iovino, Paolo Thompson, Jessica Sexton, Jessica Farry, Elizabeth Jaarsma, Trijntje Riegel, Barbara Jean
Lee, Christopher
Westland, Heleen
Faulkner, Kenneth
Iovino, Paolo
Thompson, Jessica
Sexton, Jessica
Farry, Elizabeth
Jaarsma, Trijntje
Riegel, Barbara Jean
Abstract
Objective: To characterize and explain variation in the comparative effectiveness of self-care interventions on relevant outcomes of chronic illness compared with controls.
Design: Meta-analysis and meta-regression.
Methods: Data extraction was framed within the context of a previously-published scoping review of randomized trials designed to enhance self-care in type 2 diabetes mellitus, heart failure, hypertension, asthma, coronary artery disease, and chronic obstructive pulmonary disease (published between 2008 and 2019). Data were pooled using random-effects meta-analyses. Meta-regression was used to test the effect of potential moderators on trial effectiveness.
Results: 145 trials involving 36,853 participants were included. Overall, the effect size of self-care interventions on improving outcomes was small (Hedges' g = 0.29 (95% CI = 0.25-0.33), p < 0.001) with statistically significant heterogeneity across trials (Q = 514.85, p < 0.001, I2 = 72.0%). A majority of trials (n = 83, 57.2%) were rated as having a high risk of bias. There was no statistically significant difference in trial effectiveness based on the use of theory, specific components of self-care addressed, the number of modes of delivery, the number of behavioral change techniques, specific modes of delivery, specific behavioral change techniques, intervention duration, total number of hours of intervention, or either participant age or gender.
Conclusions: Self-care interventions are modestly effective in improving outcomes. Poor trial quality limits the strength of conclusions in this area of science. There is much to be done to enhance the design, conduct and reporting of self-care trials in order to gain more insight into the effectiveness of self-care interventions.
Keywords
Asthma, Chronic obstructive pulmonary disorder, Chronic disease, Diabetes mellitusType 2, Heart failure, Hypertension, Meta-analysis, Self-care
Date
2022
Type
Journal article
Journal
Book
Volume
134
Issue
Page Range
1-12
Article Number
ACU Department
Faculty of Health Sciences
Mary MacKillop Institute for Health Research
Mary MacKillop Institute for Health Research
Collections
Relation URI
Event URL
Open Access Status
Published as green open access
License
CC BY-NC-ND 4.0
File Access
Open
Notes
© 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).