Self-management teaching programs and morbidity of pediatric asthma: A meta-analysis

Bernard-Bonnin, Anne-Claude; Stachenko, Sylvie; Bonin, Diane; Charette, Christiane; Rousseau, Élisabeth

doi:10.1016/s0091-6749(95)70150-8

Cited by 191 publications

(88 citation statements)

References 31 publications

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“…120,124,129 Six look at interventions targeted towards asthmatic children or adolescents. 118,119,121,122,125,134 The remaining nine target less specific populations and include children, adolescents, adults, HCPs, and ethnic majorities and minorities. 109,123,[126][127][128][130][131][132][133] Four reviews are linked: Zemek et al 119 provides an update of Bhogal et al 118 and both reports were included as the earlier publication was deemed to contain useful information not reported in the later update.…”

Section: Interventions Identifiedmentioning

confidence: 99%

“…118,119,121,122,125,134 The age range of the included populations varied between reviews. Two reviews included infants, 121,122 and in three reviews the youngest children were aged 4-6 years).…”

Section: Interventions Focused On a Specific Population Groupmentioning

confidence: 99%

“…134 The upper age limit was relatively consistent and ranged from 17 years 125 to 19 years. 118,119 The focus of these reviews varied, with four looking at education in various formats 121,122,125,134 and two 118,119 focusing on WAPs. Of the educational interventions, Bernard-Bonnin et al 121 explored interactive teaching conducted in both one to one or group settings; Coffman et al 125 studied school-based education; Welsh et al 134 looked at home-based self-management education programmes; and Boyd et al 122 explored educational interventions more generally.…”

Section: 119125mentioning

confidence: 99%

“…A total of 12 reviews were classified as being of higher quality (R-AMSTAR ≥ 31), [118][119][120]122,124,126,127,[130][131][132][133][134] whereas six were classed as lower quality (R-AMSTAR ≤ 30). 109,121,123,125,128,129 The total number of participants included within the reviews ranged from 113 124 to 8077. 125 Twelve reviews were of larger total size (≥ 1000) ( Table 38).…”

Section: Quality Assessment and Weightingmentioning

confidence: 99%

“…Was the scientific quality of the included studies assessed and documented? Taking into consideration both quality and total population size, one review received an overall evidence weighting of one star, 123 10 are weighted two stars, 109,[118][119][120][121]124,125,128,129,133 and seven have an evidence weighting of three stars 122,126,127,[130][131][132]134 (see Table 39 for weighting and Table 29 for the explanation on how this weighting was reached). Table 40 outlines the relevant outcome measures included in our review.…”

Section: Quality Assessment and Weightingmentioning

confidence: 99%

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A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

324

436

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BackgroundDespite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.AimTo undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.MethodsSelf-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.ResultsWe included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.ConclusionsSupporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.Study registrationThis study is registered as PROSPERO CRD42012002898.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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