Access to effective healthcare: effective self-management support intervention for patients with a chronic condition and a low social economic status: a systematic review

Background

Access to effective healthcare is in particular challenging for vulnerable and socially disadvantaged patients. Patients with chronic conditions are over-represented in these lower socioeconomic (LSES) groups. No generic review integrating the evidence on Self-Management support interventions in LSES patients with different chronic conditions exists.

Aims

To provide an overview of the effectiveness concerning patient-relevant outcomes of Self-Management support interventions and their components in chronically ill patients with a LSES.

Methods

Six databases were explored from 2000 up to December 2013. 3195 abstracts were screened. 27 studies were included. Data extraction and quality assessment were performed by five pairs of independent reviewers.

Results

The main focus was on SMSI in patients with diabetes, in the USA and 2 studies were conducted in Europe. 14 studies explicitly cited an underlying theoretical basis for the SMSI. The most frequently used Self-Management support interventions components were: lifestyle advice (n=25), information provision (n=24), and symptom management (n=22). Problem solving (n=13) and goal setting (n=13) were frequently integrated in the Self-Management support interventions. In 11 studies the Self-Management support interventions was specifically adapted to the needs of LSES patients. No differences in positive outcomes were found when stratified for theory-based Self-Management support interventions or for number of patients included.

Conclusions

Very few RCTs on Self-Management support interventions were performed in Europe. Limited evidence exists for the effectiveness of Self-Management support interventions in LSES patients and its linkages with components and strategies of these interventions. Therefore, to improve access to healthcare for all patients, it is important to develop and evaluate effective SMSI for these vulnerable patients.