What impact do chronic disease self-management support interventions have on health inequity gaps related to socioeconomic status: a systematic review

Abstract

Background: 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. Methods: Six 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. Results: Nineteen 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. Conclusions: The 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.

Changes in health inequalities for patients with diabetes among middle-aged and elderly in China from 2011 to 2015

“…A number of recent studies have demonstrated that socioeconomic status (SES) is the most decisive factor affecting health [4][5][6]. A relation exists between prevalence of diabetes and relatively disadvantaged socioeconomic position in developing and developed countries [7].…”

Segmentation of health-care consumers: psychological determinants of subjective health and other person-related variables

“…This means that acceptance may be a different characteristic for well-to-do versus poor respondents. As an example, Aldoory et al studied the use of text messaging to disseminate health information to rural lowincome mothers [55], and Hardman, Begg & Spelten assess the moderating effect of socioeconomic status on selfmanagement support (SMS) interventions [56].…”

What Matters When Exploring Fidelity in Interventions Using Health It to Reduce Disparities in Language-diverse Populations?”

“…Recent literature has called attention to the importance of evaluating Health IT interventions in ways to ensure the digital divide, is not exacerbated for low-income populations, for those with limited English pro ciency, and ethnic minority groups. In the context of expanding implementation for health IT delivered diabetes care/diabetes prevention support [27,28], it is important to understand how an expanded view of moderators of implementation delity, such as language of delivery, interact with speci ed core components, such as intervention dose, consistency or timing, when considering program sustainability, dissemination, and equity.…”