Cited by 431Chronic Disease Management StrategiesDiabetes Management and EducationHealth Policy Implementation Science

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

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Taylor, Stephanie JC, Pinnock, Hilary, Epiphaniou, Eleni, Pearce, Gemma, Parke, Hannah L, Schwappach, Anna, Purushotham, Neetha, Jacob, Sadhana +3 more·2014·Health Services and Delivery Research

Abstract

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

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  • Supportive self-management approaches are well established in the management of several chronic painful disorders, but this is not the case for chronic headache disorders.

    “Supportive self-management approaches are well established in the management of several chronic painful disorders, but this is not the case for chronic headache disorders.15–17”

    From Usual care and a self-management support programme versus usual care and a relaxation programme for people living with chronic headache disorders: A randomised controlled trial protocol (CHESS) (2020) · cites this paper as [17]

    The section ‘Support with psychological impact of long-term conditions’ (page not supplied) reports strong evidence for a component of self-management support in low back pain and rheumatoid arthritis, although benefits were not always sustained. The Methods passage (page not supplied) lists the conditions reviewed but not headache; the paper’s omission of headache does not establish that supportive self-management is not well established for chronic headache disorders. (LLM, conf=0.82)

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  • Patients enjoy the relaxation part of pain self-management programmes.

    “We know from experience that patients enjoy the relaxation part of pain self-management programmes.17”

    From Usual care and a self-management support programme versus usual care and a relaxation programme for people living with chronic headache disorders: A randomised controlled trial protocol (CHESS) (2020) · cites this paper as [17]

    Table 11 lists relaxation as a psychological strategy in self-management support, but does not report whether patients enjoy it. Searches for “enjoy,” “relaxation,” and patient appreciation in pain programmes found no passage addressing that experience; the available copy is truncated. (LLM, conf=0.72)

    Experimental — accuracy not yet measured
  • mHealth apps-medical apps in particular-offer the possibility to improve general health care issues and, more specifically, issues related to type 1 and type 2 diabetes mellitus.

    “Therefore, mHealth apps—medical apps in particular—offer the possibility to improve general health care issues and, more specifically, issues related to type 1 (T1DM) and type 2 (T2DM) diabetes mellitus [3,16-18].”

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Authors
Taylor, S. J., Pinnock, H., Epiphaniou, E., Pearce, G., Parke, H. L., Schwappach, A., Purushotham, N., Jacob, S., Griffiths, C. J., Greenhalgh, T., & Sheikh, A.
Affiliations
  • Queen Mary University of London (GB)
  • University of Edinburgh (GB)
Venue
Health Services and Delivery Research
Published
2014-12
Volume
2
Issue
53
Pages
1-580
ISSN
  • 2050-4349 (ISSN-L)
  • 2050-4357
OpenAlex
W2027619473
Cited by
431
References
279
Citations by year
2026: 11 · 2025: 33 · 2024: 52 · 2023: 34 · 2022: 33 · 2021: 35 · 2020: 51 · 2019: 42 · 2018: 35 · 2017: 39 · 2016: 36 · 2015: 25 · 2014: 3 · 2012: 1
FWCI
4.58
Type
journal article
Language
en
Open access
Locations
  • Health Services and Delivery Research (publishedVersion)
  • Edinburgh Research Explorer (University of Edinburgh) (publishedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
National Institute for Health Research (11/1014/04)
Topics
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords
self-management support, chronic disease, self-management interventions, patient education, medication adherence, patient-professional relationship, patient experience, complex interventions, personalized interventions, psychological adjustment, health care organization, asthma, type 2 diabetes, chronic obstructive pulmonary disease, depression, dementia, epilepsy, irritable bowel syndrome

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