Health Equity in the Effectiveness of Web-Based Health Interventions for the Self-Care of People With Chronic Health Conditions: Systematic Review.

Sophie Turnbull,Patricia J Lucas,Christie Cabral,Alastair Hay

doi:10.2196/17849

Abstract

BackgroundWeb-based self-care interventions have the potential to reduce health inequalities by removing barriers to access to health care. However, there is a lack of evidence about the equalizing effects of these interventions on chronic conditions.ObjectiveThis study investigated the differences in the effectiveness of web-based behavioral change interventions for the self-care of high burden chronic health conditions (eg, asthma, chronic obstructive pulmonary disease [COPD], diabetes, and osteoarthritis) across socioeconomic and cultural groups.MethodsA systematic review was conducted, following Cochrane review guidelines. We conducted searches in Ovid Medical Literature Analysis and Retrieval System Online and Cumulative Index to Nursing and Allied Health Literature databases. Studies with any quantitative design were included (published between January 1, 2006, and February 20, 2019) if they investigated web-based self-care interventions targeting asthma, COPD, diabetes, and osteoarthritis; were conducted in any high-income country; and reported variations in health, behavior, or psychosocial outcomes across social groups. Study outcomes were investigated for heterogeneity, and the possibility of a meta-analysis was explored. A narrative synthesis was provided together with a novel figure that was developed for this review, displaying heterogeneous outcomes.ResultsOverall, 7346 records were screened and 18 studies were included, most of which had a high or critical risk of bias. Important study features and essential data were often not reported. The meta-analysis was not possible due to the heterogeneity of outcomes. There was evidence that intervention effectiveness was modified by participants’ social characteristics. Minority ethnic groups were found to benefit more from interventions than majority ethnic groups. Single studies with variable quality showed that those with higher education, who were employed, and adolescents with divorced parents benefited more from interventions. The evidence for differences by age, gender, and health literacy was conflicting (eg, in some instances, older people benefited more, and in others, younger people benefited more). There was no evidence of differences in income, numeracy, or household size.ConclusionsThere was evidence that web-based self-care interventions for chronic conditions can be advantageous for some social groups (ie, minority ethnic groups, adolescents with divorced parents) and disadvantageous for other (ie, low education, unemployed) social groups who have historically experienced health inequity. However, these findings should be treated with caution as most of the evidence came from a small number of low-quality studies. The findings for gender and health literacy were mixed across studies on diabetes, and the findings for age were mixed across studies on asthma, COPD, and diabetes. There was no evidence that income, numeracy, or the number of people living in the household modified intervention effectiveness. We conclude that there appear to be interaction effects, which warrant exploration in future research, and recommend a priori consideration of the predicted interaction effects.Trial RegistrationPROSPERO CRD42017056163; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=56163

Highlights

Chronic Illness and Health InequalitiesChronic or long-term conditions such as diabetes have a significant impact on the individual’s quality of life and are the major cause of disability and premature death worldwide [1,2]
This study investigated the differences in the effectiveness of web-based behavioral change interventions for the self-care of high burden chronic health conditions across socioeconomic and cultural groups
There was evidence that web-based self-care interventions for chronic conditions can be advantageous for some social groups and disadvantageous for other social groups who have historically experienced health inequity

Summary

Introduction

Chronic Illness and Health InequalitiesChronic or long-term conditions such as diabetes have a significant impact on the individual’s quality of life and are the major cause of disability and premature death worldwide [1,2]. In high-income countries, chronic conditions are estimated to account for 87% of all deaths [3]. Due to their nature, they cause illness over long periods and their management is complex and costly [2]. Even in high-income countries, people living in constrained conditions and with a lower socioeconomic status (SES) experience chronic illness more commonly and severity is greater than average [2,8]. 52% of those from unskilled occupations suffer from chronic conditions in comparison with 33% of those in professional occupations [9] These inequalities in health have been attributed to social determinants of health (SDH) and inequity in access to health care [10]. There is a lack of evidence about the equalizing effects of these interventions on chronic conditions

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Conclusion