A systematic review examining whether community-based self-management programs for older adults with chronic conditions actively engage participants and teach them patient-oriented self-management strategies

Warner, Grace; Packer, Tanya L.; Kervin, Emily; Sibbald, Kaitlin; Audulv, Åsa

doi:10.1016/j.pec.2019.07.002

Cited by 38Chronic Disease Management StrategiesDiabetes Management and EducationNursing care and research

A systematic review examining whether community-based self-management programs for older adults with chronic conditions actively engage participants and teach them patient-oriented self-management strategies

Warner, Grace, Packer, Tanya L., Kervin, Emily, Sibbald, Kaitlin, Audulv, Åsa·2019·Patient Education and Counseling

DOI 10.1016/j.pec.2019.07.002

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Abstract

Objective To identify whether community-based Self-Management Programs (SMPs) actively engaged, or taught, individuals patient-oriented strategies; and whether having these attributes led to significant differences in outcomes.Methods This systematic review included randomized controlled trials (RCTs)and cluster RCTs reporting on community-based SMPs with a group component for older adults with chronic conditions. The ways SMPS actively engaged participants and whether they taught patient-oriented strategies were analyzed. All study outcomes were reported.Results The 31 included studies demonstrated community-based SMP programs actively engaged participants and provided strategies to improve health behaviour or care of their condition. Few included strategies to help manage the impact of conditions on their everyday lives. Seventy-nine percent of studies reported significant differences; variations in sample sizes and outcomes made it difficult to conclude whether having these attributes led to significant differences.Conclusion SMPs are not supporting older adults to use strategies to address the impact of conditions on their everyday lives, addressing the needs of older adults with multiple conditions, nor assessing outcomes that align with the strategies taught.Practice implications Health-care providers delivering SMPs to older adults need to tailor programs to the needs of older adults and assess whether participants are using strategies being proposed.

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Many in-person chronic disease management and self-management programs, particularly those for older adults, are condition specific and have structured content delivered in a 6- to 8-week period, usually consisting of weekly sessions.
“Many, particularly those for older adults, who are the most likely to have chronic conditions, are condition specific and have structured content that is delivered in a 6- to 8-week period, usually consisting of weekly sessions [11].”
From Features of Structured, One-to-One Videoconference Interventions That Actively Engage People in the Management of Their Chronic Conditions: Scoping Review (2025) · cites this paper as [11]
The 7 TEDSS domains have been used to successfully identify and describe content in self-management interventions, including in scoping reviews.
“The 7 distinctive TEDSS domains (Textbox 2) have been used to successfully identify and describe content in self-management interventions [32,33], including in scoping reviews [11,34].”
From Features of Structured, One-to-One Videoconference Interventions That Actively Engage People in the Management of Their Chronic Conditions: Scoping Review (2025) · cites this paper as [11]
Over 50% of programs had content aligned with the same 4 domains (disease control, healthy behaviors, internal, and process) of the TEDSS framework, findings that mimic those of others using the TEDSS framework.
“Over 50% of the programs (18/25, 72%; disease and control domain: 14/25, 56%; healthy behavior domain: 13/25, 52%; internal domain: 13/25, 52%) had content aligned with the same 4 domains (disease control, healthy behaviors, internal, and process) of the TEDSS framework, findings that mimic those of others using the TEDSS framework to analyze program content and program outcome measures [11,75].”
From Features of Structured, One-to-One Videoconference Interventions That Actively Engage People in the Management of Their Chronic Conditions: Scoping Review (2025) · cites this paper as [11]
The paucity of intervention programs addressing clients' role management has been highlighted in other reviews, as has the limited focus on finding and managing formal and informal resources.
“The paucity of intervention programs addressing clients’ role management has been highlighted in other reviews [11,75], as has the limited focus on finding and managing formal and informal resources [34].”
From Features of Structured, One-to-One Videoconference Interventions That Actively Engage People in the Management of Their Chronic Conditions: Scoping Review (2025) · cites this paper as [11]

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Flagged first, then by citations

4 of the 92 references couldn’t be matched to a known paper.

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Exercise-based interventions for post-stroke social participation: A systematic review and network meta-analysis
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“However, this review highlighted that SMPs need to broaden the strategies to be more patient-centered by helping older adults manage the impact of the conditions on their daily lives, and to provide strategies for managing interacting symptoms, treatments, and everyday problems due to the high prevalence of multiple m…”
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“Moreover, self-management programs that mainly focus on what providers decide is important, rather than what patients think is important, have not been successful when it comes to supporting patients with strategies to improve their self-management (4).”
Background
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Faria, A. D. C. A., Martins, M. M., Ribeiro, O. M. P. L., Ventura‐Silva, J. M. A., Teles, P., & Laredo‐Aguilera, J. A. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19095435 · Cited by 5 · see citing works
“Thus, the Directorate-General of Health (DGS) and the World Health Organization (WHO) underline the importance of health professionals who exercise their functions in the community in implementing programs that promote health literacy, healthy lifestyles, and empowering self-management to cope with disease processes,…”
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Self-management in Older Adults with Multiple Chronic Conditions (MCCs): A Qualitative Content Analysis
Sadeghi, H., Shahboulaghi, F. M., Hosseini, M., Fallahi‐Khoshknab, M., & Harouni, G. G. (2024) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.5812/ijpbs-150346 · Cited by 3 · see citing works
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Ogrin, R., Aylen, T., Thurgood, L., Neoh, S. L., Audehm, R. G., Steel, P., Churilov, L. P., Zajac, J. D., & Ekinci, E. I. (2021) · Clinical Diabetes · doi:10.2337/cd20-0129 · Cited by 3 · see citing works
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Measuring Integrated Care – Methodological Reflections from Monitoring and Evaluation Process of the PHC Plus Pilot Program in Poland
Kozieł, A., Görgens, M., Chawla, M., Król-Jankowska, A., & Kononiuk, A. (2023) · International Journal of Integrated Care · doi:10.5334/ijic.6646 · Cited by 4 · see citing works
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Santos, C., Fernandes, C. S., Bastos, C., Cruz, M. A., Costa, S., & Lima, L. (2023) · Enfermería Clínica · doi:10.1016/j.enfcli.2023.06.007 · Cited by 3 · see citing works
Development and psychometric evaluation of the catheter assessment, management and performance (CAMP) scale for nurses
Alex, J., Ramjan, L. M., Ferguson, C., Fishburn, M. L., Montayre, J., & Salamonson, Y. (2024) · Nurse Education in Practice · doi:10.1016/j.nepr.2024.104122 · Cited by 4 · see citing works
Features of Structured, One-to-One Videoconference Interventions That Actively Engage People in the Management of Their Chronic Conditions: Scoping Review
Chen, Y.-T., Lehman, M., Van Denend, T., Kish, J., Wu, Y., Preissner, K., Plow, M., & Packer, T. L. (2025) · Journal of Medical Internet Research · doi:10.2196/58543 · Cited by 3 · see citing works
“The paucity of intervention programs addressing clients’ role management has been highlighted in other reviews [11,75], as has the limited focus on finding and managing formal and informal resources [34].”
InfluentialSelf-citation
NECESSIDADES DOS IDOSOS NA AUTOGESTÃO DA DOENÇA CRÔNICA: PERSPECTIVANDO UM PROGRAMA DE INTERVENÇÃO DE ENFERMAGEM
Bastos, C., Santos, C., Martins, M. M., Fernandes, C. S., & Lima, L. (2021) · Cogitare Enfermagem · doi:10.5380/ce.v26i0.83048 · Cited by 2 · see citing works
Self-initiated management strategies in digitalized work and everyday life – experiences of people with cognitive difficulties due to neurological disorders
Lindberg, M., Lexell, E. M., Ranner, M., & Larsson-Lund, M. (2023) · Scandinavian Journal of Occupational Therapy · doi:10.1080/11038128.2023.2175724 · Cited by 2 · see citing works
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“Although previous studies have highlighted the benefits of asthma educational programmes (Coombs et al., 2018; Warner et al., 2019; Zhong et al., 2017) they provide little information about the factors that can undermine the usefulness of such programmes.”
Background
Perceptions of mindfulness practices as a support for individuals managing caregiving responsibilities and chronic disease: A qualitative study
West, N. T., Harmon, B. E., Rawlett, K. E., Short, S. J., Spanier, A. J., Mathews, S., Kimble, K., McGehee, C., Ratliff, M. L., & Puett, R. C. (2023) · Chronic Illness · doi:10.1177/17423953231170401 · Cited by 2 · see citing works
“7,9,11 Given psychological stress and anxiety can trigger physiological reactions such as in ﬂ ammation and dysregulation of the immune system, which can worsen health and disease management, 12 there is a need for programs addressing both the mental and physical health stressors experienced by…”
Background
Factors Associated with Risk of Fall in Elderly Population
Naseer, B., Dastgir, H., Sadiq, A., Salik, S., Abid, N., & Tayyab, M. (2022) · The Healer Journal of Physiotherapy and Rehabilitation Sciences · doi:10.55735/hjprs.v2i3.84 · Cited by 1 · see citing works
A qualitative study of clinicians’ and individuals’ with lower limb loss perspectives on the development of a novel online self-management program
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“Research, through systematic review, has indicated that self-management programs have the capacity to actively engage older adults living with chronic conditions like Parkinson’s Disease, stroke, or cancer [13].”
Monitoring of Older Adult’s Joint Pain Management by Families Based on Information Technology (IT) Platform
Istifada, R., Iswati, I., Susila, W. D. C., Ramadhani, D. Y., & Laagu, M. A. (2023) · Adi Husada Nursing Journal · doi:10.37036/ahnj.v9i2.451 · Cited by 1 · see citing works
“Self-management is an effort to improve the patient's ability to manage signs and symptoms, treatment, physical and psychosocial consequences, and lifestyle changes due to chronic illness (Warner et al., 2019).”
Background
Tackling malnutrition: impact and nutritional solutions later in life
Verwijs, M. H. (2021) · doi:10.18174/550165
An Open Group for Patients with Various Chronic Illnesses: A Qualitative Case Evaluation
Shah, J., Kovacs, M., & Mori, D. L. (2023) · International Journal of Group Psychotherapy · doi:10.1080/00207284.2022.2154674
“Finally, in a recent systematic review of self-management programs (SMPs) for older adults with chronic medical conditions, Warner et al. (2019) concluded that SMPs typically focus most on process strategies associated with managing conditions (e.g., setting goals, improving adherence), without…”
BackgroundInfluential
A pilot, randomized, feasibility study to improve health self-management behaviors in older adults with multiple chronic conditions and functional limitations: Protocol for the Behavioral Activation and Occupational Therapy Trial (BA+OT)
Klinedinst, T. C., Ciro, C. A., & Kendzor, D. E. (2023) · Journal of Multimorbidity and Comorbidity · doi:10.1177/26335565231163037
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Santos, C., Fernandes, C. S., Bastos, C., Cruz, M. A., Costa, S., & Lima, L. (2023) · Enfermería Clínica (English Edition) · doi:10.1016/j.enfcle.2023.09.001
Feasibility study of the internet-based intervention ‘Strategies for Empowering activities in Everyday life’ (SEE 2.0) for use by people with chronic diseases and long-term disorders in healthcare: a study protocol
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Intervention based on the family health nurse model on hypertension in the elderly: Protocol for a randomized clinical trial
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Analytical hierarchy process (AHP) ranking of criteria for staying active and healthy in old age
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The Social Life of Chronic Disease: How Illness Reshapes Identity, Relationships, Adaptation, and Long-Term Healthcare Engagement
Tanaka, K., Kobayashi, Y., & Nakamura, T. (2026) · International Journal of Social and Psychological Aspects of Healthcare · doi:10.51847/cq4oqhbiz3

Self‐Management at the Tipping Point: Reaching 100,000 Americans with Evidence‐Based Programs
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Self-citation
The Effectiveness of a Chronic Disease Self-Management Program for Elderly People: a Systematic Review
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Authors: Warner, G., Packer, T. L., Kervin, E., Sibbald, K., & Audulv, Å.
Affiliations: Dalhousie University (CA)
HAN University of Applied Sciences (NL)
Mount Saint Vincent University (CA)
Mid Sweden University (SE)
Corresponding author: Warner, Grace
ORCID: Warner, Grace
Packer, Tanya L.
Kervin, Emily
Sibbald, Kaitlin
Audulv, Åsa
Venue: Patient Education and Counseling
Publisher: Elsevier BV
Published: 2019-12
Volume: 102
Issue: 12
Pages: 2162-2182
ISSN: 0738-3991 (ISSN-L)
DOI: 10.1016/j.pec.2019.07.002
OpenAlex: W2954995277
Cited by: 38
References: 92
Citations by year: 2026: 5 · 2025: 3 · 2024: 5 · 2023: 10 · 2022: 3 · 2021: 6 · 2020: 6
FWCI: 0.55
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Patient Education and Counseling (publishedVersion)
PubMed (publishedVersion)
Funders: Nova Scotia Health Research Foundation (PSO - KTE - 2009 – 6318)
Topics: Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Health Sciences › Health Professions › Pharmacy › Nursing care and research
Keywords: self-management program, older adults, chronic disease, community-based intervention, participant engagement, health behavior change, multimorbidity, program tailoring
MeSH terms: Self-Management, Aged, Chronic Disease, Community Health Services, Humans, Patient Participation, Quality of Life, Self Care, Randomized Controlled Trials as Topic, Outcome Assessment, Health Care, Disease Management

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A systematic review examining whether community-based self-management programs for older adults with chronic conditions actively engage participants and teach them patient-oriented self-management strategies

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