Abstract
The prevalence of chronic disease associated with unhealthy lifestyles has been increasing worldwide. Health professionals have recognized that self-management programs (SMPs) can provide health benefits by promoting health behaviors, especially when applied to individuals with lifestyle-related chronic disease. This review performed a meta-analysis of the features of SMPs using randomized studies and analyzed the magnitude of the combined effects of self-management on behavioral modification. We searched the PubMed, CINAHL, ScienceDirect, SCOPUS, Web of Science, Embase, Cochrane Library, DBpia, and KISS to identify randomized trials that evaluated the behavioral outcomes of SMPs. Subgroup analyses were performed for program duration, providers, type of comparisons, and program settings. We selected 25 studies (N = 5,681) to perform analyses with random-effects models. The effect sizes of SMPs were small but significant for physical activity (standardized difference in means [SDM] = 0.25), dietary habits (SDM = 0.28), and health responsibility (SDM = 0.18), and not significant for stress management and smoking behaviors. A short-term SMPs (less than 12 weeks) was indicated as being effective in modifying physical activity, dietary habits, and health responsibility, while the program effects on dietary habits were significant only with expert-delivered education and when compared with inactive controls. The findings of this study indicate that SMPs can effectively improve physical activity, dietary habits, and health responsibility in individuals with chronic disease, with a small but significant effect size. Future studies should explore the effects of SMPs on stress management and smoking cessation and assess the long-term maintenance of healthy lifestyles in individuals with lifestyle-related chronic disease.
Highlights
Chronic disease associated with unhealthy lifestyle is currently the most common cause of mortality worldwide, accounting for approximately 31% of all deaths [1, 2]
Interventions for preventing lifestyle-related chronic diseases focus on managing modifiable cardiovascular risk factors, long-term behavioral modifications that increase physical activity, improving dietary habits, improving health responsibility and stress management, and cessation of smoking and alcohol consumption [4]
Previous randomized controlled trials (RCTs) of patients with chronic disease and modifiable cardiovascular risk factors have consistently found that self-management program (SMP) have positive effects on behavioral modifications, which leads to risk reduction and improved quality of life [10,11,12]
Summary
Chronic disease associated with unhealthy lifestyle is currently the most common cause of mortality worldwide, accounting for approximately 31% of all deaths [1, 2]. Effects of self-management programs that contribute to the development of lifestyle-related chronic disease include smoking, high cholesterol, poor dietary habits, lack of physical activity, stress, and obesity [3]. Interventions for preventing lifestyle-related chronic diseases focus on managing modifiable cardiovascular risk factors, long-term behavioral modifications that increase physical activity, improving dietary habits, improving health responsibility and stress management, and cessation of smoking and alcohol consumption [4]. Since most of the lifestyle-related chronic disease is dependent on self-management, behavioral modification through SMP is considered the most important treatment strategy. Previous randomized controlled trials (RCTs) of patients with chronic disease and modifiable cardiovascular risk factors have consistently found that SMPs have positive effects on behavioral modifications, which leads to risk reduction and improved quality of life [10,11,12]. While a previous meta-analysis of SMPs mostly examined physiological outcomes for patients with chronic diseases [13], SMPs focus on the behavioral aspect of chronic disease management, for which those with lifestyle-related chronic disease have not been assessed
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