Telephone based self-management support by ‘lay health workers’ and ‘peer support workers’ to prevent and manage vascular diseases: a systematic review and meta-analysis
Open accessAbstract
BACKGROUND: Improved prevention and management of vascular disease is a global priority. Non-health care professionals (such as, 'lay health workers' and 'peer support workers') are increasingly being used to offer telephone support alongside that offered by conventional services, to reach disadvantaged populations and to provide more efficient delivery of care. However, questions remain over the impact of such interventions, particularly on a wider range of vascular related conditions (such as, chronic kidney disease), and it is unclear how different types of telephone support impact on outcome. This study assessed the evidence on the effectiveness and cost-effectiveness of telephone self-management interventions led by 'lay health workers' and 'peer support workers' for patients with vascular disease and long-term conditions associated with vascular disease. METHODS: Systematic review of randomised controlled trials. Three electronic databases were searched. Two authors independently extracted data according to the Cochrane risk of bias tool. Random effects meta-analysis was used to pool outcome measures. RESULTS: Ten studies were included, primarily based in community settings in the United States; with participants who had diabetes; and used 'peer support workers' that shared characteristics with patients. The included studies were generally rated at risk of bias, as many methodological criteria were rated as 'unclear' because of a lack of information.Overall, peer telephone support was associated with small but significant improvements in self-management behaviour (SMD = 0.19, 95% CI 0.05 to 0.33, I2 = 20.4%) and significant reductions in HbA1c level (SMD = -0.26, 95% CI -0.41 to -0.11, I2 = 47.6%). There was no significant effect on mental health quality of life (SMD = 0.03, 95% CI -0.12 to 0.18, I2 = 0%). Data on health care utilisation were very limited and no studies reported cost effectiveness analyses. CONCLUSIONS: Positive effects were found for telephone self-management interventions via 'lay workers' and 'peer support workers' for patients on diabetes control and self-management outcomes, but the overall evidence base was limited in scope and quality. Well designed trials assessing non-healthcare professional delivered telephone support for the prevention and management of vascular disease are needed to identify the content of effective components on health outcomes, and to assess cost effectiveness, to determine if such interventions are potentially useful alternatives to professionally delivered care.
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Taking into account quality assessment, explicit self-management focus, and total population size, 8 reviews received an evidence weighting of 3 stars, 23 received 2 stars, 21 received 1 star, and 1 received no stars.
“Taking into account quality assessment, explicit self-management focus, and total population size, 8 reviews received an evidence weighting of 3 stars [16,21,25,26,38,45,53,56], 23 received 2 stars [22,24,27-31, 33,37,40,42,44,46,49,50,52,54,55,58,62,63,67,68], 21 received 1 star [19,20,23,32,34-36,39,43,47,48,51,57, 59-61,64-66,69,70], and 1 received no stars [41].”
Four of the mixed diabetes reviews were awarded a 3-star weighting.
“Of these, 4 were awarded a 3-star weighting [16,25,38,45], of which Farmer et al [25] , Small et al [45], and Liang et al [38] analyzed control or health care utilization outcomes, or both.”
Small et al reviewed telephone-only interventions incorporating lay health workers and showed a small but significant improvement in HbA1c over usual care.
“Small et al reviewed telephone-only interventions incorporating “lay health workers” and showed a small but significant improvement in HbA1c over usual care [45].”
Supported education and information interventions were particularly effective in the context of diabetes, with 9 larger systematic reviews showing evidence of improvement in HbA1c.
“Supported education and information interventions were particularly effective in the context of diabetes, with 9 larger systematic reviews showing evidence of improvement in HbA1c [27,30,35-37,40,44-46].”
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Thompson, D. M., Booth, L., Moore, D., & Mathers, J. (2022) · Figshare · doi:10.6084/m9.figshare.19498258
Additional file 1 of Peer support for people with chronic conditions: a systematic review of reviews
Thompson, D. M., Booth, L. R., Moore, D., & Mathers, J. (2022) · Figshare · doi:10.6084/m9.figshare.19498249
Additional file 2 of Peer support for people with chronic conditions: a systematic review of reviews
Thompson, D. M., Booth, L., Moore, D., & Mathers, J. (2022) · Figshare · doi:10.6084/m9.figshare.19498252
Additional file 5 of Peer support for people with chronic conditions: a systematic review of reviews
Thompson, D. M., Booth, L., Moore, D., & Mathers, J. (2022) · Figshare · doi:10.6084/m9.figshare.19498261
Additional file 3 of Peer support for people with chronic conditions: a systematic review of reviews
Thompson, D. M., Booth, L., Moore, D., & Mathers, J. (2022) · Figshare · doi:10.6084/m9.figshare.19498255
Wickens, M. M., Bragg‐Gresham, J. L., Saran, R., Tandan, M., Argentina, M., Chatoth, D. K., Damron, K. C., Sjoding, M. W., Krein, S. L., Le, V., et al. (2026) · Journal of Medical Internet Research · doi:10.2196/93049
- Authors
- Small, N., Blickem, C., Blakeman, T., Panagioti, M., Chew-Graham, C. A., & Bower, P.
- Affiliations
- Manchester Academic Health Science Centre (GB)
- Keele University (GB)
- Corresponding author
- Small, Nicola
- Venue
- BMC Health Services Research
- Published
- 2013-12
- Volume
- 13
- Issue
- 1
- Pages
- 533-533
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC3880982
- OpenAlex
- W2129239577
- Cited by
- 50
- References
- 46
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 4 · 2022: 10 · 2021: 2 · 2020: 6 · 2019: 4 · 2018: 5 · 2017: 5 · 2016: 4 · 2015: 5 · 2014: 1
- FWCI
- 0.49
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Liverpool John Moores University (acceptedVersion)
- Keele Research Repository (Keele University) (submittedVersion, cc-by)
- Health Services Research
- Funders
- National Institute for Health and Care Research (CL-2009-06-004)
- University of Manchester
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- lay health workers, peer support workers, vascular disease, diabetes mellitus, HbA1c, self-management behavior, chronic kidney disease, chronic disease, cost-effectiveness, community-based care
- MeSH terms
- Community Health Services, Cost-Benefit Analysis, Humans, Peer Group, Self Care, Telephone, Vascular Diseases, Treatment Outcome
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