Abstract
BackgroundThe social gradient in chronic disease (CD) is well-documented, and the ability to effectively self-manage is crucial to reducing morbidity and mortality from CD. This systematic review aimed to assess the moderating effect of socioeconomic status on self-management support (SMS) interventions in relation to participation, retention and post-intervention outcomes.MethodsSix databases were searched for studies of any design published until December 2018. Eligible studies reported on outcomes from SMS interventions for adults with chronic disease, where socioeconomic status was recorded and a between-groups comparison on SES was made. Possible outcomes were participation rates, retention rates and clinical or behavioural post-intervention results.ResultsNineteen studies were retrieved, including five studies on participation, five on attrition and nine studies reporting on outcomes following SMS intervention. All participation studies reported reduced engagement in low SES cohorts. Studies assessing retention and post-intervention outcomes had variable results, related to the diversity of interventions. A reduction in health disparity was seen in longer interventions that were individually tailored. Most studies did not provide a theoretical justification for the intervention being investigated, although four studies referred to Bandura’s concept of self-efficacy.ConclusionsThe limited research suggests that socioeconomic status does moderate the efficacy of SMS interventions, such that without careful tailoring and direct targeting of barriers to self-management, SMS may exacerbate the social gradient in chronic disease outcomes. Screening for patient disadvantage or workload, rather than simply recording SES, may increase the chances of tailored interventions being directed to those most likely to benefit from them. Future interventions for low SES populations should consider focussing more on treatment burden and patient capacity.Trial registrationPROSPERO registration CRD42019124760. Registration date 17/4/19.
Highlights
The social gradient in chronic disease (CD) is well-documented, and the ability to effectively selfmanage is crucial to reducing morbidity and mortality from CD
Self-management support (SMS) approaches have been developed to give people the skills to more effectively manage their health. These interventions involve both education and behaviour change strategies to address the medical, physical, emotional and social challenges associated with CD, aiming to help the person adapt to their changed circumstances whilst still leading a meaningful life [4, 5, 7]
We looked for four main chronic conditions: cardiovascular disease (CVD), musculoskeletal conditions (MSK), pulmonary disease (COPD) and diabetes
Summary
The social gradient in chronic disease (CD) is well-documented, and the ability to effectively selfmanage is crucial to reducing morbidity and mortality from CD. This systematic review aimed to assess the moderating effect of socioeconomic status on self-management support (SMS) interventions in relation to participation, retention and post-intervention outcomes. Self-management support (SMS) approaches have been developed to give people the skills to more effectively manage their health. These interventions involve both education and behaviour change strategies to address the medical, physical, emotional and social challenges associated with CD, aiming to help the person adapt to their changed circumstances whilst still leading a meaningful life [4, 5, 7]. Self-efficacy theory refers to an individual’s belief or confidence in their capacity to undertake tasks or achieve goals, which can translate into health behaviour change and by implication, improved health status [4, 5]
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