Association between patient activation, self-management behaviours and clinical outcomes in adults with diabetes or related metabolic disorders: a systematic review and meta-analysis protocol

Abstract

IntroductionDiabetes and related metabolic disorders such as obesity and cardiovascular diseases (CVD) are a growing global issue. Equipping individuals with the necessary ‘knowledge, skills and confidence to self-manage their health’ (ie, patient activation (PAct)) may lead to improvements in health outcomes. It is unclear whether existing evidence allows us to assume a causal relationship. We aim to synthesise and critically appraise evidence on the relationship between PAct and self-management behaviours and clinical outcomes of people living with diabetes and related metabolic disorders.Methods and analysisThe protocol is based on guidance on Preferred Reporting Items for Systematic Review and Meta-analysis Protocols. We will search Medline, Embase, CENTRAL, PsycInfo, Web of Science and CINAHL using search terms related to PAct, diabetes, pre-diabetes, obesity and CVD. Any quantitative study design is eligible provided studies assess the association between PAct and clinical outcomes and/or self-management behaviours of diabetes and related metabolic disorders. Outcomes include behavioural (eg, diet) and clinical (eg, blood pressure) outcomes. Two reviewers will independently screen titles/abstracts and full texts and assess risk of bias using the revised Cochrane risk-of-bias tool for randomised trials or the Risk of Bias Assessment Tool for Nonrandomised Studies (RoBANS).One reviewer will extract data, with independent checking by a second reviewer. We will critically assess the level of evidence available for assuming a causal association between PAct and outcomes. Data permitting, we will use the Hunter-Schmidt random-effects method to meta-analyse correlations across studies.Ethics and disseminationEthical approval is not required. The review will be disseminated in the form of a peer-reviewed journal article, at conferences and other presentations. The findings of the review will be of interest to clinical commissioning groups, policymakers and intervention deliverers/developers.PROSPERO registration numberCRD42021230727.

A randomized prospective trial of an ostomy telehealth intervention for cancer survivors

“…Several systematic reviews indicate that the PAM is predictive of most health behaviors and many health outcomes. [13][14][15][16][17] The SE questionnaire for ostomy was modified from the self-efficacy to perform self-management behaviors scale of Lorig et al 18 An outcome measure for chronic disease management interventions, this scale represents eight domains and has strong psychometric properties. 18 The COH-QOL-O questionnaire was designed for all adult ostomates and has a fourdimensional HRQOL (physical, psychological, social, and spiritual well-being) framework on 0-10 scales.…”

“…The 13‐item PAM uses a unidimensional, probabilistic Guttman‐like scale with strong psychometric properties. Several systematic reviews indicate that the PAM is predictive of most health behaviors and many health outcomes 13–17 . The SE questionnaire for ostomy was modified from the self‐efficacy to perform self‐management behaviors scale of Lorig et al 18 .…”