Abstract
BackgroundSuccessful chronic care self-management requires adherence to healthy lifestyle behaviors, but many healthcare-based health promotion interventions have resulted in small and unsustainable changes in patient behavior. Patients with chronic conditions may already be overwhelmed by burdensome illnesses and treatments, and not have the capacity to respond well to the additional work required of behavior modifications. To explore this phenomenon, we will apply the cumulative complexity model (CCM), a patient-centered model of patient complexity, to a systematic review and meta-analysis of healthcare-based health behavior interventions.Methods/DesignThis systematic review will include randomized trials published between 2002 and 2012 that compared healthcare-based interventions aimed at improving healthy diet and physical activity in community dwelling adult patients with chronic conditions. After extracting study and risk of bias features from each trial, we will classify the interventions according to the conceptual model. We will then use meta-analysis and subgroup analysis to test hypotheses based on the conceptual model.DiscussionHealthcare providers need evidence of successful health promoting interventions for patients with chronic conditions who display common behavioral risk factors. To better understand how patients respond to interventions, we will apply the CCM, which accounts for both the capacity of patients with chronic conditions and their treatment-related workload, and posits that a balance between capacity and workload predicts successful enactment of self-care. Analysis will also include whether patients with multiple chronic conditions respond differently to interventions compared to those with single chronic conditions. The results of this review will provide insights as to how patients with chronic conditions respond to health-promoting interventions.Review registrationPROSPERO registration number: CRD42012003428
Highlights
Successful chronic care self-management requires adherence to healthy lifestyle behaviors, but many healthcare-based health promotion interventions have resulted in small and unsustainable changes in patient behavior
To better understand how patients respond to interventions, we will apply the cumulative complexity model (CCM), which accounts for both the capacity of patients with chronic conditions and their treatment-related workload, and posits that a balance between capacity and workload predicts successful enactment of self-care
Analysis will include whether patients with multiple chronic conditions respond differently to interventions compared to those with single chronic conditions
Summary
The results of this review will inform researchers and practitioners as to how clinical health promotion interventions impact health behaviors of adults with chronic conditions. We postulate that interventions will be more successful if they consider the existing capacity and workload of patients with chronic conditions and seek to enhance patients’ capacity for performing health behaviors without adding an unsustainable workload of demands. Intervention designs that capitalize on, support, and build patients’ capacity to routinize and adapt to their chronic conditions and successfully implement behavior change into their lives may prove more successful. Initial increases in a patient’s workload may be required for enactment of health behavior change; this workload may increase their capacity to manage their conditions, resulting in decreased burden of illness
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