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Cited by 499Telemedicine and Telehealth ImplementationMobile Health and mHealth ApplicationsDiabetes Management and Education

Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer

Open access
Hanlon, Peter, Daines, Luke, Campbell, Christine, McKinstry, Brian, Weller, David, Pinnock, Hilary·2017·Journal of Medical Internet Research
DOI 10.2196/jmir.6688PMC PMC5451641
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Abstract

BACKGROUND: Self-management support is one mechanism by which telehealth interventions have been proposed to facilitate management of long-term conditions. OBJECTIVE: The objectives of this metareview were to (1) assess the impact of telehealth interventions to support self-management on disease control and health care utilization, and (2) identify components of telehealth support and their impact on disease control and the process of self-management. Our goal was to synthesise evidence for telehealth-supported self-management of diabetes (types 1 and 2), heart failure, asthma, chronic obstructive pulmonary disease (COPD) and cancer to identify components of effective self-management support. METHODS: We performed a metareview (a systematic review of systematic reviews) of randomized controlled trials (RCTs) of telehealth interventions to support self-management in 6 exemplar long-term conditions. We searched 7 databases for reviews published from January 2000 to May 2016 and screened identified studies against eligibility criteria. We weighted reviews by quality (revised A Measurement Tool to Assess Systematic Reviews), size, and relevance. We then combined our results in a narrative synthesis and using harvest plots. RESULTS: We included 53 systematic reviews, comprising 232 unique RCTs. Reviews concerned diabetes (type 1: n=6; type 2, n=11; mixed, n=19), heart failure (n=9), asthma (n=8), COPD (n=8), and cancer (n=3). Findings varied between and within disease areas. The highest-weighted reviews showed that blood glucose telemonitoring with feedback and some educational and lifestyle interventions improved glycemic control in type 2, but not type 1, diabetes, and that telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure, but these findings were not consistent in all reviews. Results for the other conditions were mixed, although no reviews showed evidence of harm. Analysis of the mediating role of self-management, and of components of successful interventions, was limited and inconclusive. More intensive and multifaceted interventions were associated with greater improvements in diabetes, heart failure, and asthma. CONCLUSIONS: While telehealth-mediated self-management was not consistently superior to usual care, none of the reviews reported any negative effects, suggesting that telehealth is a safe option for delivery of self-management support, particularly in conditions such as heart failure and type 2 diabetes, where the evidence base is more developed. Larger-scale trials of telehealth-supported self-management, based on explicit self-management theory, are needed before the extent to which telehealth technologies may be harnessed to support self-management can be established.

Verified 2026-10-06 · 2 references not checked yet

AI snapshot

Written from the paper’s full text.

TL;DR

This metareview synthesized 53 systematic reviews (231 unique RCTs per Results; abstract says 232) of telehealth interventions to support self-management in diabetes, heart failure, asthma, COPD, and cancer. Evidence was inconsistent and no single self-management component was consistently effective, but no reviews reported harm, with the strongest support in type 2 diabetes and heart failure.

Key findings

  • Included 53 systematic reviews comprising 231 unique RCTs (119 diabetes, 58 heart failure, 28 asthma, 23 COPD, 3 cancer); the abstract reports 232 unique RCTs. Findings varied between and within disease areas.
  • Highest-weighted reviews showed blood glucose telemonitoring with feedback and some educational/lifestyle interventions improved glycemic control in type 2, but not type 1, diabetes; telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure, though findings were not consistent in all reviews.
  • No reviews showed evidence of harm; results for asthma, COPD, and cancer were mixed, and more intensive/multifaceted interventions were associated with greater improvements in diabetes, heart failure, and asthma.
  • Analysis of the mediating role of self-management and of components of successful interventions was limited and inconclusive; no single self-management component was consistently effective or ineffective.

Methods

  • Metareview (systematic review of systematic reviews) of RCTs of telehealth interventions to support self-management in 6 long-term conditions; searched 7 databases for reviews published January 2000 to May 2016.
  • Included 53 reviews; quality assessed with R-AMSTAR (scores 19–43 out of 44) and weighted by quality, size, and explicit self-management focus (8 reviews 3 stars, 23 reviews 2 stars, 21 reviews 1 star, 1 review no stars).
  • Because RCT overlap precluded meta-analysis, findings were combined in narrative synthesis and harvest plots; data were extracted from reviews, not individual RCTs, covering disease control, health care utilization, self-management process, and quality-of-life outcomes.

Limitations

  • Stated: metareview lag risks outdated results; reliance on review authors’ interpretation; inability to adjust for geography, age, or socioeconomic variables; RCT overlap risks overrepresenting some trials; only 6 conditions were considered; inclusion of reviews with implied self-management focus was potentially subjective; few reviews assessed publication bias.
  • Stated: most reviews did not analyze intervention intensity or specific components, limiting conclusions about which components or combinations are most beneficial.
  • Evident from the text: the abstract and Results report different unique RCT counts (232 vs 231); heterogeneity and poor intervention reporting limit component analysis; harvest plot rules may overlook individual RCTs.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2196/jmir.6688

Cites

76 of 78 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

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  • Findingnone given

    The findings that telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure were not consistent in all reviews.

    “that telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure, but these findings were not consistent in all reviews.”
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  • Findingnone given

    Analysis of components of successful interventions was limited and inconclusive.

    “Analysis of the mediating role of self-management, and of components of successful interventions, was limited and inconclusive.”
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  • Findingown data

    Telemonitoring and telephone interventions reduced hospital admissions in heart failure.

    “that telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure, but these findings were not consistent in all reviews.”
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  • Findingnone given

    Telehealth-mediated self-management was not consistently superior to usual care.

    “While telehealth-mediated self-management was not consistently superior to usual care, none of the reviews reported any negative effects”
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    Findings varied between and within disease areas.

    “Findings varied between and within disease areas.”
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    Findingown data

    The metareview included 53 systematic reviews, comprising 232 unique RCTs.

    “We included 53 systematic reviews, comprising 232 unique RCTs.”
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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].”
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    The year of publication of included reviews ranged from 2000 to 2016.

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    Information on the geographical spread of the RCTs included within the systematic reviews was incomplete.

    “Information on the geographical spread of the RCTs included within the SRs was incomplete, but included studies from North and South America, Europe, Asia, and Oceania.”
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    Findingown data

    Five reviews focused on type 1 diabetes and one analyzed type 1 diabetes within a mixed review.

    “A total of 5 reviews focused on type 1 diabetes [23,24,41,48,49] and 1 analyzed type 1 diabetes within a mixed review [19].”
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    Included studies came from North and South America, Europe, Asia, and Oceania.

    “Information on the geographical spread of the RCTs included within the SRs was incomplete, but included studies from North and South America, Europe, Asia, and Oceania.”
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    Three 1-star narrative syntheses showed improvement in HbA1c limited to only a few RCTs, and all concluded that further evaluation was required.

    “Three 1-star narrative syntheses showed improvement in HbA1c limited to only a few RCTs, and all concluded that further evaluation was required [19,23,48].”
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    Narrative syntheses found that telehealth-delivered educational interventions and telephone interventions did not improve glycemic control.

    “Narrative syntheses found that telehealth-delivered educational interventions [52] and telephone interventions [29] did not improve glycemic control.”
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    Two of the type 2 diabetes reviews were awarded a 3-star weighting.

    “Of these, 2 were awarded a 3-star weighting [21,53].”
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    de Jongh et al focused on mobile messaging interventions, including medication reminders, and found no improvement in HbA1c compared with usual care in a meta-analysis of 2 RCTs.

    “The former focused on mobile messaging interventions, including medication reminders, and found no improvement in hemoglobin A1c (HbA1c) compared with usual care in a meta-analysis of 2 RCTs [24].”
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    Interventions in the meta-analyses showing significant HbA1c reductions included telemonitoring of blood glucose and mobile messaging.

    “Interventions included telemonitoring of blood glucose [33,42,54] and mobile messaging [46].”
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    The reviews of de Jongh et al and Viana et al were both weighted 2 stars.

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    Of seven 2-star reviews, four were meta-analyses, all of which showed significant reductions in HbA1c compared with controls, although the effect sizes were small.

    “Of seven 2-star reviews [29,30,33,42,46,52,54], 4 were meta-analyses, all of which showed significant reductions in HbA1c compared with controls, although the effect sizes were small.”
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    Farmer et al assessed telemonitoring of self-monitored blood glucose and found no significant improvement in HbA1c in a meta-analysis of 9 RCTs, and either no difference or an increase in health care utilization in 6 RCTs.

    “Farmer et al assessed telemonitoring of self-monitored blood glucose and found no significant improvement in HbA1c in a meta-analysis of 9 RCTs, and either no difference or an increase in health care utilization in 6 RCTs [25].”
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    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.”
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    Interventions in the 2-star mixed diabetes meta-analyses included telemonitoring of blood sugar and interactive telehealth excluding telephone support.

    “Interventions included telemonitoring of blood sugar [40,44] and interactive telehealth excluding telephone support [27].”
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    Four of the 2-star mixed diabetes reviews included meta-analyses of impact on HbA1c, with three showing significant improvements over controls.

    “A total of 8 reviews were weighted 2 stars [22,27,28,31,37,40,44,50]; 4 of these included meta-analyses of impact on HbA1c, with 3 showing significant improvements over controls.”
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    A 2-star narrative review showed no mortality benefit from telephone-only interventions and a variable effect on hospital admissions.

    “In contrast, a 2-star narrative review showed no mortality benefit from telephone-only interventions and a variable effect on hospital admissions [55].”
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    Some studies reported improvements in asthma symptom scores; however, most showed no benefit.

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    The highest weighted heart failure review (Ciere et al, 3 stars) did not include any disease control outcomes, nor did three others.

    “The highest weighted of these (Ciere et al, 3 stars) did not include any disease control outcomes [56], nor did 3 others [16,59,60].”
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    Both structured telephone support and telemonitoring reduced all-cause mortality in heart failure.

    “Self-management support was explicitly hypothesized as a mechanism by which these interventions might exert their effect, and both interventions reduced all-cause mortality.”
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    Heart failure hospitalizations, but not all-cause hospital admissions, were significantly lower with either telemonitoring or telephone support.

    “Heart failure hospitalizations, but not all-cause hospital admissions, were also significantly lower with either telemonitoring or telephone support.”
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    Both de Jongh et al and Marcano Belisario et al highlighted the potential benefit from some positive findings in the studies but acknowledged that these findings were not consistent and that the evidence base required development.

    “Both highlighted the potential benefit from some positive findings in the studies but acknowledged that these findings were not consistent and that the evidence base required development.”
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    The highest weighted asthma reviews each scored 2 stars, including three narrative syntheses and one meta-analysis.

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    McLean et al analyzed a wide range of telehealth interventions, including structured telephone support, education support, telemonitoring, and action plan components.

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    A 1-star meta-analysis of telemonitoring for heart failure (excluding telephone interventions) showed a significant reduction in mortality and heart failure admissions, but not all-cause admissions or emergency department visits.

    “A 1-star weighted meta-analysis of telemonitoring for heart failure (excluding telephone interventions) showed a significant reduction in mortality and heart failure admissions, but not all-cause admissions or emergency department visits [57].”
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    de Jongh et al and Marcano Belisario et al reviewed mobile interventions and smartphone apps, respectively; the number of included RCTs was small for both (1 and 2).

    “de Jongh et al [24] and Marcano Belisario et al [62] reviewed mobile interventions and smartphone apps, respectively. The number of included RCTs was small for both (1 and 2, respectively).”
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    Meta-analyses showed no significant improvement in emergency department use or hospitalization at 3 months, but a significant reduction in hospitalizations compared with usual care at 12 months.

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    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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    Lundell et al showed a significant improvement in physical activity with telehealth, but no impact on dyspnea.

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    Both 2-star COPD meta-analyses concerned home-based telehealth using a variety of technologies, incorporating information transmission with personalized feedback.

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    Ciere et al specifically analyzed whether the beneficial effects of telehealth interventions on clinical outcomes were mediated by increases in knowledge, self-care, or self-efficacy.

    “The highest weighted of the heart failure reviews (Ciere et al) specifically analyzed whether the beneficial effects of telehealth interventions on clinical outcomes were mediated by increases in knowledge, self-care, or self-efficacy [56].”
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    Another meta-analysis, weighted 1 star, showed no impact on mortality but evidence of fewer hospitalizations in a narrative synthesis.

    “Another meta-analysis, weighted 1 star, showed no impact on mortality but evidence of fewer hospitalizations in a narrative synthesis [69].”
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    The COPD reviews included 2 meta-analyses, both weighted 2 stars.

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    No single self-management component was found to be consistently effective, or consistently ineffective.

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    Findingcitation

    A 2-star weighted review of multiple conditions included a narrative synthesis of 5 RCTs of interactive telehealth interventions, excluding telephone-only support, and concluded no overall evidence of benefit in asthma.

    “A 2-star weighted review of multiple conditions included a narrative synthesis of 5 RCTs of interactive telehealth interventions, excluding telephone-only support, and concluded no overall evidence of benefit in asthma [27].”
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    Ciere et al found that evidence linking telehealth interventions with increased knowledge or self-care behaviors, or linking self-efficacy with self-care, was ambiguous.

    “They found that evidence linking telehealth interventions with increased knowledge or self-care behaviors, or linking self-efficacy with self-care was “ambiguous,” and concluded that, on the basis of their findings and the poor methodological quality of the included studies, the evidence neither supports nor refutes their models [56].”
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    Four reviews (3 meta-analyses and 1 narrative synthesis) analyzed the impact of telehealth on all-cause mortality, and none showed a significant difference versus usual care.

    “A total of 4 reviews (3 meta-analyses and 1 narrative syntheses) analyzed the impact of telehealth on all-cause mortality, and none showed a significant difference versus usual care [65,66,68,69,71,72].”
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    Findingcitation

    The other cancer review analyzed Internet-based education programs linking patients with clinicians and found no improvement in quality of life in 2 RCTs and an improvement in symptom scores in 1 of the RCTs.

    “The other review analyzed Internet-based education programs linking patients with clinicians and found no improvement in quality of life in 2 RCTs and an improvement in symptom scores in 1 of the RCTs [70].”
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    Findingcitation

    Teleconsultations, videoconferencing, and telephone follow-up designed to review symptoms or clinical course were important aspects of telehealth interventions described by Inglis et al for heart failure, whose meta-analysis showed reduced mortality and heart failure hospital admission with telemonitoring and telephone review.

    “Teleconsultations, videoconferencing, and telephone follow-up designed to review symptoms or clinical course were important aspects of telehealth interventions described by Inglis et al for heart failure, whose meta-analysis showed reduced mortality and heart failure hospital admission with telemonitoring and telephone review [58].”
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    Findingown data

    Fewer reviews focused on adherence support or lifestyle interventions than on other components, and several of those did not report disease control outcomes.

    “Fewer reviews focused on adherence support or lifestyle interventions, and, of those that did, several did not report disease control outcomes.”
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    Diabetes and heart failure constituted the greatest evidence base, with available data on cancer being very limited.

    “Diabetes and heart failure constituted the greatest evidence base, with available data on cancer being very limited.”
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    Findingown data

    Most included reviews either provided limited description of the interventions or did not specifically analyze the impact of individual components on the efficacy of the intervention as a whole.

    “most of the included reviews either provided limited description of the interventions or did not specifically analyze the impact of individual components on the efficacy of the intervention as a whole.”
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    Findingcitation

    The highest-weighted evidence showed improvement in HbA1c in type 2 diabetes with interventions remotely monitoring blood glucose and in some more intensive telephone interventions.

    “The highest-weighted evidence showed improvement in HbA1c in type 2 diabetes with interventions remotely monitoring blood glucose and in some more intensive telephone interventions [31,38,53].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [31] source

      Not checked in the free run.

    • cites [38] source

      Not checked in the free run.

    • cites [53] source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Cassimatis et al.'s 2-star review of behavioral interventions (excluding telemonitoring) found some improvements in self-care, dietary and medication adherence, and physical activity, but the effect was inconsistent.

    “Cassimatis et al (2 stars) analyzed behavioral interventions (excluding telemonitoring) and found some improvements in self-care, dietary and medication adherence, and physical activity, but the effect was inconsistent [22].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Ciere et al concluded that the evidence neither supports nor refutes their models.

    “They found that evidence linking telehealth interventions with increased knowledge or self-care behaviors, or linking self-efficacy with self-care was “ambiguous,” and concluded that, on the basis of their findings and the poor methodological quality of the included studies, the evidence neither supports nor refutes their models [56].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Several diabetes reviews included elements of remote clinical review, with some reporting positive outcomes.

    “Several diabetes reviews included elements of remote clinical review, with some reporting positive outcomes [27,30,40].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [27] source

      Not checked in the free run.

    • cites [30] source

      Not checked in the free run.

    • cites [40] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Cassimatis et al. highlighted that more intensive lifestyle interventions appeared to have a greater impact on glycemic control.

    “Cassimatis et al highlighted in their analysis that more intensive lifestyle interventions appeared to have a greater impact on glycemic control [22].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Few reviews specifically considered or assessed for publication bias, and of those that did, some found evidence to suggest bias.

    “few reviews specifically considered or assessed for publication bias and, of those that did, some found evidence to suggest bias [38,46].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [38] source

      Not checked in the free run.

    • cites [46] source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    The individual long-term conditions considered in this metareview differed both in the quantity of evidence for telehealth interventions supporting self-management and in the findings and conclusions of the included systematic reviews.

    “The individual long-term conditions considered in this metareview differed both in the quantity of evidence for telehealth interventions supporting self-management and in the findings and conclusions of the included systematic reviews.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingcitation

    Greenwood et al. defined 7 separate components of telehealth: patient education, health care provider education, self-monitoring profile, blood glucose goals, use of blood glucose data to modify behavior, feedback to patients, and 2-way interaction.

    “They defined 7 separate components of telehealth (patient education, health care provider education, self-monitoring profile, blood glucose goals, use of blood glucose data to modify behavior, feedback to patients, and 2-way interaction).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Physiological telemonitoring and telephone support for heart failure were associated with reduced mortality and heart failure-specific hospital admissions.

    “Physiological telemonitoring and telephone support for heart failure were associated with reduced mortality and heart failure-specific hospital admissions [58].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [58] source

      Not checked in the free run.

  • May combine two claims.

    Findingreasoning

    Findings varied by disease group and by components of telehealth delivery.

    “Findings varied by disease group and by components of telehealth delivery.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    The impact of telehealth-supported self-management on disease control and health care utilization was inconsistent, with positive outcomes more frequently identified in type 2 diabetes and heart failure and often no effect demonstrated in other conditions.

    “The impact of telehealth-supported self-management on disease control and health care utilization was inconsistent, with positive outcomes more frequently identified in type 2 diabetes and heart failure and often no effect demonstrated in other conditions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Clinical review, adherence support, and lifestyle interventions also showed some positive results, but with substantial inconsistency.

    “Clinical review, adherence support, and lifestyle interventions also showed some positive results, but with substantial inconsistency.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    We found little explicit evidence of a mediating role for self-management in telehealth interventions and the specific components that may encourage self-care.

    “We found little explicit evidence of a mediating role for self-management in telehealth interventions and the specific components that may encourage self-care.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    No single component was consistently effective in any disease area, although none were associated with harm.

    “No single component was consistently effective in any disease area, although none were associated with harm.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The greatest volume of evidence was for educational interventions and monitoring of clinical data incorporating feedback, and several reviews, notably those with higher weighting, demonstrated improved outcomes in some (notably type 2 diabetes) but not all conditions.

    “The greatest volume of evidence was for educational interventions and monitoring of clinical data incorporating feedback, and several reviews, notably those with higher weighting, demonstrated improved outcomes in some (notably type 2 diabetes) but not all conditions (Figure 2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    For type 2 diabetes and heart failure, findings were inconsistent between reviews, and analyses of similar interventions reached different conclusions.

    “For both of these conditions, however, findings were inconsistent between reviews, and analyses of similar interventions reached different conclusions [25,55,57].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [25] source

      Not checked in the free run.

    • cites [55] source

      Not checked in the free run.

    • cites [57] source

      Not checked in the free run.

  • May combine two claims.

    Findingreasoning

    There was some evidence for telehealth-delivered adherence support in asthma and diabetes, but this was variable and inconsistent.

    “There was some evidence for telehealth-delivered adherence support in asthma and diabetes, but this was variable and inconsistent.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The rising prevalence of long-term conditions is a major clinical and public health challenge.

    “The rising prevalence of long-term conditions is a major clinical and public health challenge [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    Telehealth has attracted considerable interest as a means of delivering care to those with long-term conditions.

    “Telehealth has attracted considerable interest as a means of delivering care to those with long-term conditions [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Self-management is increasingly recognized as important for effective management of long-term conditions.

    “Self-management—whereby individuals take on tasks to deal with medical management, role management, or emotional aspects of their condition [6]—is also increasingly recognized as important for effective management of long-term conditions [7-9].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [7] Department of HealthOur health, our care, our say: a new direction for community services20062016-09-21London, UKThe Stationary Officehttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/272238/6737.pdf

      Not checked in the free run.

    • cites [8] Department of HealthA new approach to chronic disease management for the 21st century20012016-09-21http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4018578.pdf

      Not checked in the free run.

    • cites [9] World Health OrganizationInnovative care for chronic conditions: building blocks for action20122016-09-21Geneva, SwitzerlandWHOhttp://www.who.int/chp/knowledge/publications/icccglobalreport.pdf

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Telehealth is a safe option for delivery of self-management support, particularly in heart failure and type 2 diabetes where the evidence base is more developed.

    “suggesting that telehealth is a safe option for delivery of self-management support, particularly in conditions such as heart failure and type 2 diabetes, where the evidence base is more developed.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The included systematic reviews adequately assessed and reported harms or negative effects, so the absence of reported harm indicates that telehealth is safe.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The protocol could not be registered because PROSPERO does not accept protocols for metareviews.

    “We were unable to register our protocol as PROSPERO (an international prospective register of systematic reviews) does not accept protocols for metareviews.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Quality of included reviews was assessed using the R-AMSTAR quality assessment tool.

    “We assessed the quality of the included reviews using the revised A Measurement Tool to Assess Systematic Reviews (R-AMSTAR) quality assessment tool.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    A random sample of 250 abstracts was screened by 2 reviewers.

    “A random sample of 250 abstracts was screened by 2 reviewers (PH and LD).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Self-management support interventions need to be tailored to the individual and their specific condition and context.

    “A systematic overview of self-management interventions (Practical Reviews in Self-Management Support [PRISMS]) demonstrated that self-management support interventions across a range of 14 long-term conditions are complex and multifaceted, involve both the patient and health care professional, and need to be tailored to the individual and their specific condition and context [12].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] Taylor, S, 2014, Southampton (UK); NIHR Journals Library

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Data were extracted using a piloted data extraction template and each study was checked for accuracy.

    “Data were extracted using a piloted data extraction template for included studies (PH), and each study was checked for accuracy (LD).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Self-management support interventions across a range of 14 long-term conditions are complex and multifaceted.

    “A systematic overview of self-management interventions (Practical Reviews in Self-Management Support [PRISMS]) demonstrated that self-management support interventions across a range of 14 long-term conditions are complex and multifaceted, involve both the patient and health care professional, and need to be tailored to the individual and their specific condition and context [12].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] Taylor, S, 2014, Southampton (UK); NIHR Journals Library

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The PRISMS review found that no single component of self-management interventions could be identified as being more important than others.

    “The review found that no single component of self-management interventions could be identified as being more important than others, but also that the detail and quality of reporting of these complex interventions was a barrier to their wider implementation and the understanding of their effective components [12,13].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [12] Taylor, S, 2014, Southampton (UK); NIHR Journals Library

      Not checked in the free run.

    • cites [13] Hoffmann, TC, 2013, BMJ source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Rules were devised and refined by discussion between the authors to underpin decisions about whether a review showed a positive, negative, or no effect.

    “These were devised and refined by discussion between the authors and are described in Table 3.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The kappa statistic of agreement for abstract screening was high (0.96).

    “A kappa statistic of agreement was calculated using IBM SPSS version 22 (IBM Corporation) and was high (0.96).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Each included review was assessed independently by 2 reviewers and disagreements were resolved by discussion.

    “Each included review was assessed independently by 2 reviewers (PH and LD) and disagreements were resolved by discussion.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Telehealth has been proposed as one mechanism by which self-management may be promoted and enabled.

    “Telehealth has been proposed as one mechanism by which self-management may be promoted and enabled [10]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] Steventon, A, 2012, BMJ source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Full texts of all potentially eligible articles were assessed independently by 2 reviewers.

    “Full texts of all potentially eligible articles were assessed independently by 2 reviewers (PH and LD).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    Overlap in included RCTs precluded meta-analysis of the review findings, so a narrative synthesis was undertaken.

    “The overlap in included RCTs (ie, reviews with similar inclusion criteria may include the same RCTs) precluded meta-analysis of the review findings; we therefore undertook a narrative synthesis.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The included reviews' findings can be meaningfully combined in a narrative synthesis and harvest plots despite heterogeneity in outcomes and methods.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Self-management support interventions involve both the patient and health care professional.

    “A systematic overview of self-management interventions (Practical Reviews in Self-Management Support [PRISMS]) demonstrated that self-management support interventions across a range of 14 long-term conditions are complex and multifaceted, involve both the patient and health care professional, and need to be tailored to the individual and their specific condition and context [12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Taylor, S, 2014, Southampton (UK); NIHR Journals Library

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Inclusion criteria were piloted by 2 authors and disagreements were resolved by discussion with all authors.

    “Inclusion criteria were piloted by 2 authors (PH and HP) and disagreements were resolved by discussion with all authors.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The metareview was carried out according to a prespecified protocol.

    “We carried it out according to a prespecified protocol.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Several of the PRISMS taxonomy components could be potentially delivered via telehealth.

    “Several of these components could be potentially delivered via telehealth, and may be grouped and considered under the following headings:”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The PRISMS taxonomy identified 14 separate components that might be adapted and used to support self-management across a range of long-term conditions.

    “This taxonomy identified 14 separate components that might be adapted and used to support self-management across a range of long-term conditions.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Active self-monitoring of blood glucose data appeared to be most consistently associated with improved outcomes, although this was not consistent across reviews.

    “Active self-monitoring of blood glucose data appeared to be most consistently associated with improved outcomes, although this was not consistent across reviews.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Evidence for telephone support was more limited, although it may be effective as part of intensive interventions.

    “Evidence for telephone support was more limited, although it may be effective as part of intensive interventions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Benefits from telehealth interventions were unlikely in mild asthma but those at higher risk of hospitalization may benefit.

    “The authors concluded that benefits were unlikely in mild asthma but that those at higher risk of hospitalization may benefit.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [63] source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationcitation

    Despite some positive findings, the telehealth interventions were components in complex interventions and further evaluation would be required to clarify their role in COPD.

    “The authors emphasized that, despite some positive findings, the telehealth interventions were components in complex interventions and further evaluation would be required to clarify their role in COPD [68].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [68] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Greenwood et al. concluded that a range of these components need to be incorporated into telehealth interventions for clinically significant improvements in diabetes self-management to be seen.

    “The authors concluded that a range of these components need to be incorporated into telehealth interventions for clinically significant improvements in diabetes self-management to be seen.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A recent metareview of heart failure telemonitoring interventions showed a reduction in all-cause mortality (relative risk 0.60-0.85) and heart failure hospitalizations (relative risk 0.64-0.86) in an analysis of 15 meta-analyses.

    “A recent metareview of heart failure telemonitoring interventions showed a reduction in all-cause mortality (relative risk 0.60-0.85) and heart failure hospitalizations (relative risk 0.64-0.86) in an analysis of 15 meta-analyses [74].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    We designed the rules used to determine how each review was displayed in the harvest plots to ensure that the assessment of reviews was consistent and transparent.

    “We designed the rules used to determine how each review was displayed in the harvest plots to ensure that the assessment of reviews was consistent and transparent.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    We developed clear rules for the inclusion criteria and undertook duplicate full-text screening, but this might have resulted in some inappropriate inclusions or exclusions due to limited description of interventions.

    “However, we developed clear rules for the inclusion criteria and undertook duplicate full-text screening, but this might have resulted in some inappropriate inclusions or exclusions due to limited description of interventions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Greenwood et al. concluded that a range of components (including educational, self-monitoring, goal-driven, and interactive elements) were important in improving glycemic control and emphasized the multifaceted nature of self-management support.

    “Greenwood et al concluded that a range of components (including educational, self-monitoring, goal-driven, and interactive elements) were important in improving glycemic control [30] and emphasized the multifaceted nature of self-management support.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    While telehealth interventions were not consistently found to be superior to usual care, none of the reviews reported any negative effects, suggesting that telehealth is a safe alternative mode of delivery for self-management support, particularly in conditions such as heart failure and type 2 diabetes, where the evidence base is more developed.

    “While telehealth interventions were not consistently found to be superior to usual care, none of the reviews reported any negative effects, suggesting that telehealth is a safe alternative mode of delivery for self-management support, particularly in conditions such as heart failure and type 2 diabetes, where the evidence base is more developed.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    Any systematic review is limited by the time delay from completion of a primary study to publication and subsequently conducting the review itself; by reviewing systematic reviews, this lag time is further extended and the results risk being out of date.

    “Any systematic review is limited by the time delay from completion of a primary study to publication, and subsequently conducting the review itself. By reviewing systematic reviews, this lag time is further extended and, as such, the results risk being out of date”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    By relying on systematic review findings, the evidence is one step removed from the empirical evidence and reliant on the interpretation of the review authors; this was mitigated to some extent by assessing methodological quality and using this to weight the evidence.

    “By relying on systematic review findings, the evidence is 1 step removed from the empirical evidence, and thus reliant on the interpretation of the review authors. This was mitigated to some extent by assessing the methodological quality of the reviews and using this to weight the evidence.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Specifying that more than 50% of RCTs in a narrative synthesis must show positive results for a review to be considered as having consistently positive findings avoids overly optimistic interpretation, but risks overlooking individual RCTs that may be particularly relevant to the review question.

    “Specifying that more than 50% of RCTs in a narrative synthesis must show positive results for a review to be considered as having consistently positive findings avoids overly optimistic interpretation, but risks overlooking individual RCTs that may be particularly relevant to the review question.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Interventions with multiple components, or more intensive interventions, may be associated with greater benefits.

    “Interventions with multiple components, or more intensive interventions, may be associated with greater benefits [30,53,63,68].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [30] source

      Not checked in the free run.

    • cites [53] source

      Not checked in the free run.

    • cites [63] source

      Not checked in the free run.

    • cites [68] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    An overview of telehealth across a number of conditions noted modest improvements in HbA1c in some reviews with others noting no overall effect.

    “An overview of telehealth across a number of conditions noted modest improvements in HbA1c in some reviews with others noting no overall effect [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Study design and conductreasoning

    A metareview such as this is well suited to forming an overview of the topic, but loses granularity and detail of the evidence, a limitation particularly evident when attempting to analyze components of self-management support.

    “A metareview such as this is thus well suited to forming an overview of the topic, but loses granularity and detail of the evidence, a limitation particularly evident when attempting to analyze components of self-management support.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    There is overlap in the included RCTs, which risks overrepresenting the results of a few RCTs included in several systematic reviews and giving a false impression of consensus.

    “There is also overlap in the included RCTs, which risks overrepresenting the results of a few RCTs included in several systematic reviews and giving a false impression of consensus.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Improvements may be more readily seen in those with more severe disease.

    “Improvements may be more readily seen in those with more severe disease.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A strength of metareview methodology is that it allows a relatively rapid synthesis of a large body of primary literature and enables a broad overview of a subject area.

    “A strength of metareview methodology is that it allows a relatively rapid synthesis of a large body of primary literature and enables a broad overview of a subject area [15].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Overlap precludes meta-analysis, but the use of harvest plots provides a visual synthesis of the findings of each individual review.

    “Overlap precludes meta-analysis, but the use of harvest plots provides a visual synthesis of the findings of each individual review.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    We identified reviews that focused specifically on self-management and incorporated this into the weighting system, so as to minimize the impact of this limitation on the interpretation of the findings.

    “In addition, we identified reviews that focused specifically on self-management and incorporated this into the weighting system, so as to minimize the impact of this limitation on the interpretation of the findings.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    The decision to adopt telehealth strategies will be determined not only by clinical or demographic circumstances but also by patient or clinician preference.

    “The decision to adopt telehealth strategies will be determined not only by clinical or demographic circumstances but also by patient or clinician preference.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Taken together, it appears that, while not consistently superior to usual care, telehealth is a safe alternative mode of delivery for self-management support, particularly in conditions such as heart failure and type 2 diabetes, where the evidence base is more developed.

    “Taken together, it appears that, while not consistently superior to usual care, telehealth is a safe alternative mode of delivery for self-management support, particularly in conditions such as heart failure and type 2 diabetes, where the evidence base is more developed.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Qualitative methodologies have highlighted that users valued convenience, a sense of being "watched over", and finding the telemonitoring data reassuring.

    “Such questions have been addressed using qualitative methodologies [75], which have highlighted that users valued convenience [76], a sense of being “watched over” [11,77], and finding the telemonitoring data reassuring [78].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [75] Medical Research CouncilDeveloping and evaluating complex interventions: new guidance20062016-09-21Swindon, UKMRChttp://www.mrc.ac.uk/documents/pdf/complex-interventions-guidance/

      Not checked in the free run.

    • cites [76] source

      Not checked in the free run.

    • cites [11] source

      Not checked in the free run.

    • cites [77] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Study design and conductnone given

    We selected common conditions, 5 of which had a good evidence base for telehealth or self-management, or both, and included 1 area (cancer) in which these concepts are still at an early stage.

    “However, we selected common conditions, 5 of which had a good evidence base for telehealth or self-management, or both, and included 1 area (cancer) in which these concepts are still at an early stage.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    The relative lack of data for cancer may reflect a lack of research in this field or simply that the available evidence has yet to be synthesized in a systematic review.

    “The relative lack of data for cancer may reflect a lack of research in this field or simply that the available evidence has yet to be synthesized in a systematic review.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    This metareview considered only 6 long-term conditions and may have reached different conclusions had we selected a different set of conditions.

    “This metareview considered only 6 long-term conditions and may have reached different conclusions had we selected a different set of conditions.”
    Quote in the paperNot a substantial claim
109 of 109

  • The paper relies on this without support.

    The included systematic reviews adequately assessed and reported harms or negative effects, so the absence of reported harm indicates that telehealth is safe.

    “none of the reviews reported any negative effects”
    “no reviews showed evidence of harm”

  • The paper relies on this without support.

    The extent to which telehealth effectively promotes self-management, and the components of telehealth interventions that contribute to this goal, remain unclear.

    “The extent to which telehealth effectively promotes self-management, and the components of telehealth interventions that contribute to this goal, remain unclear.”

  • The paper relies on this without support.

    The included reviews' findings can be meaningfully combined in a narrative synthesis and harvest plots despite heterogeneity in outcomes and methods.

    “we therefore undertook a narrative synthesis”
    “We used harvest plots to illustrate the disease control outcomes related to telehealth-supported self-management components [17,18].”

  • The paper relies on this without support.

    The included systematic reviews collectively provide a sufficiently complete and unbiased evidence base for the metareview's conclusions about telehealth for self-management of the six conditions.

    “By relying on systematic review findings, the evidence is 1 step removed from the empirical evidence, and thus reliant on the interpretation of the review authors.”

  • The paper relies on this without support.

    The six selected long-term conditions are representative enough to generalize the metareview's conclusions about telehealth for self-management to long-term conditions more broadly.

    “This metareview considered only 6 long-term conditions and may have reached different conclusions had we selected a different set of conditions.”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • COPD mortality review designs do not match their descriptions

    Minor

    The four included reviews cited for COPD mortality are 65, 66, 68, and 69. The text elsewhere identifies 65 and 66 as narrative syntheses and 68 and 69 as meta-analyses, contradicting the stated split of three meta-analyses and one narrative synthesis.

  • Conflicting counts of unique RCTs

    Minor

    The abstract reports 232 unique RCTs, while the Results reports 231. The disease-specific counts in the Results also sum to 231.

  • Cancer reviews' star weightings conflict with the weighting list

    Minor

    The cancer section says both reviews were weighted 2 stars, but the earlier weighting list assigns review 21 three stars and review 70 one star.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 5

  1. Taylor, S, 2014, Southampton (UK); NIHR Journals Library, 1
  2. 2009, Ont Health Technol Assess Ser, 9, 1
  3. Jaana, M, 2009, Am J Manag Care, 15, 313
  4. Franek, J, 2012, Ont Health Technol Assess Ser, 12, 1
  5. 10.1016/j.pop.2012.03.005 · DOI

Cited by

Sorted by citations

Related

Authors
Hanlon, P., Daines, L., Campbell, C., McKinstry, B., Weller, D., & Pinnock, H.
Affiliations
University of Edinburgh (GB)
Corresponding author
Pinnock, Hilary
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2017-05-17
Volume
19
Issue
5
Pages
e172
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/jmir.6688
PMC
PMC5451641
OpenAlex
W2609520421
Semantic Scholar
2aade83dc64d7ebc9bc9436027ed04c36c2fd2af
Cited by
499
References
78
Citations by year
2026: 22 · 2025: 47 · 2024: 64 · 2023: 67 · 2022: 79 · 2021: 75 · 2020: 55 · 2019: 55 · 2018: 30 · 2017: 5
FWCI
6.44
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
Funders
National Institute for Health and Care Research (RP-DG-1213-10008, 11/1014/04)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
self-management support, chronic disease, diabetes mellitus, type 1 diabetes, type 2 diabetes, heart failure, asthma, chronic obstructive pulmonary disease, cancer, glycemic control, hospitalization, mortality, health care utilization, intervention components, telephone-delivered intervention, educational intervention, lifestyle intervention, mediating role
MeSH terms
Self-Management, Asthma, Chronic Disease, Delivery of Health Care, Diabetes Mellitus, Type 2, Heart Failure, Humans, Neoplasms, Telemedicine, Pulmonary Disease, Chronic Obstructive

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

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