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Implementation of Self-Management Interventions in Chronic Disease Care: Challenges and Lessons Learned

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (1 July 2022) | Viewed by 11235

Special Issue Editors

Netherlands Institute for Health Services Research, 3513 CR Utrecht, The Netherlands
Interests: self-management; empowerment; chronic diseases; diversity; health literacy; implementation research; gender differences; social capital

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Assistant Guest Editor
Avedis Donabedian Research Institute, Autonomous University of Barcelona (UAB), Avedis Donabedian Foundation, 08193 Bellaterra, Barcelona, Spain
Interests: patient-centered care; self-management; patient empowerment; patient safety; implementation science; scaling up of interventions; quality improvement

Special Issue Information

Dear Colleagues,

This Special Issue of the International Journal of Environmental Research and Public Health will be devoted to the implementation of effective and/or cost-effective interventions in order to support the self-management of individuals with chronic conditions.

Population ageing and increasing chronic illness burden have sparked interest in innovative care models. Self-management support has been highlighted as a key strategy for addressing chronic disease burdens. Over the last decades, many interventions have been developed so as to support patients and their families with the daily management of their chronic disease.

Self-management interventions are complex interventions. Although there is promising evidence that self-management interventions can improve clinical outcomes and patient-reported outcomes, such as quality of life, self-efficacy, or adherence in numerous chronic conditions, these interventions often get stuck in the phase of research, do not get structurally implemented in healthcare, or do not reach the patient groups that need them the most.

Traditional methods of review focus on measuring and reporting on intervention effectiveness; often end with evidence that is mixed or conflicting; and provide little or no clue as to why the intervention worked or did not work when applied in different contexts or circumstances, deployed by different stakeholders, or used for different purposes or outcomes.

Therefore, a better understanding of the facilitators and barriers to successful implementation of (cost-) effective self-management interventions is essential. Contextual factors at various levels (system, organisation, patient–provider interaction, and patient) can all influence SMI uptake, engagement, and success. Improving our understanding of how these factors influence the effectiveness and cost-effectiveness of SMIs for chronic illness is urgently needed.

We encourage you to submit original empirical studies, as well as systematic reviews, realist reviews, or meta-analyses. Short reports and methodological papers will also be considered. In particular, we encourage the submission of interdisciplinary work and multi-country collaborative research, as well as manuscripts that address (but are not limited to) the implementation of self-management interventions, applied to the following fields:

  • Hard to reach populations (e.g., people with limited health literacy, people living in rural or remote areas, minority groups, or people with less social or financial resources)
  • Multidisciplinary settings
  • People suffering from co-morbidity and multi-morbidity
  • Descriptions of development, validation, or the evaluation of self-management interventions in health care and the community in which the implementation factors are addressed
  • Empirical studies (quantitative, qualitative, and mixed methods) applied to any subject related to self-management interventions (broadly defined) in high- and/or low-resource environments.

 

Dr. Monique Heijmans
Dr. Carola Orrego
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Chronic diseases
  • Self-management
  • Complex interventions
  • Contextual factors
  • Implementation research

Published Papers (4 papers)

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Research

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24 pages, 1411 KiB  
Article
Using a Taxonomy to Systematically Identify and Describe Self-Management Interventions Components in Randomized Trials for COPD
Int. J. Environ. Res. Public Health 2022, 19(19), 12685; https://doi.org/10.3390/ijerph191912685 - 04 Oct 2022
Cited by 3 | Viewed by 2251
Abstract
Self-management interventions (SMIs) may improve outcomes in Chronic Obstructive Pulmonary Disease (COPD). However, accurate comparisons of their relative effectiveness are challenging, partly due to a lack of clarity and detail regarding the intervention content being evaluated. This study systematically describes intervention components and [...] Read more.
Self-management interventions (SMIs) may improve outcomes in Chronic Obstructive Pulmonary Disease (COPD). However, accurate comparisons of their relative effectiveness are challenging, partly due to a lack of clarity and detail regarding the intervention content being evaluated. This study systematically describes intervention components and characteristics in randomized controlled trials (RCTs) related to COPD self-management using the COMPAR-EU taxonomy as a framework, identifying components that are insufficiently incorporated into the design of the intervention or insufficiently reported. Overall, 235 RCTs published between 2010 and 2018, from a systematic review were coded using the taxonomy, which includes 132 components across four domains: intervention characteristics, expected patient (or caregiver) self-management behaviours, patient relevant outcomes, and target population characteristics. Risk of bias was also assessed. Interventions mainly focused on physical activity (67.4%), and condition-specific behaviours like breathing exercise (63.5%), self-monitoring (50.8%), and medication use (33.9%). Support techniques like education and skills-training, self-monitoring, and goal setting (over 35% of the RCTs) were mostly used for this. Emotional-based techniques, problem-solving, and shared decision-making were less frequently reported (less than 15% of the studies). Numerous SMIs components were insufficiently incorporated into the design of COPD SMIs or insufficiently reported. Characteristics like mode of delivery, intensity, location, and providers involved were often not described. Only 8% of the interventions were tailored to the target population’s characteristics. Outcomes that are considered important by patients were hardly taken into account. There is still a lot to improve in both the design and description of SMIs for COPD. Using a framework such as the COMPAR-EU SMI taxonomy may contribute to better reporting and to better informing of replication efforts. In addition, prospective use of the taxonomy for developing and reporting intervention content would further aid in building a cumulative science of effective SMIs in COPD. Full article
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15 pages, 354 KiB  
Article
To Adapt or Not to Adapt: The Association between Implementation Fidelity and the Effectiveness of Diabetes Self-Management Education
Int. J. Environ. Res. Public Health 2021, 18(8), 4095; https://doi.org/10.3390/ijerph18084095 - 13 Apr 2021
Viewed by 2295
Abstract
Self-management education (SME) is a key determinant of diabetes treatment outcomes. While SME programs are often adapted for implementation, the impact of adaptations on diabetes SME effectiveness is not well documented. This study evaluated the impact of the implementation fidelity of diabetes SME [...] Read more.
Self-management education (SME) is a key determinant of diabetes treatment outcomes. While SME programs are often adapted for implementation, the impact of adaptations on diabetes SME effectiveness is not well documented. This study evaluated the impact of the implementation fidelity of diabetes SME programs on program effectiveness, exploring which factors influence implementation fidelity. Data from 33 type 2 diabetes SME program providers and 166 patients were collected in 8 countries (Austria, Belgium, Germany, Ireland, UK, Israel, Taiwan and USA). Program providers completed a questionnaire assessing their adherence to the program protocol and factors that influenced the implementation. Patients answered a pre–post questionnaire assessing their diabetes-related health literacy, self-care behavior, general health and well-being. Associations between implementation fidelity and outcomes were estimated through logistic regressions and repeated measures MANOVA, controlling for potential confounders. Adaptations of the program protocol regarding content, duration, frequency and/or coverage were reported by 39% of the providers and were associated with better, not worse, outcomes than strict adherence. None of the factors related to the participants, facilitating strategies, provider or context systematically influenced the implementation fidelity. Future research should focus on individual and contextual factors that may influence decisions to adapt SME programs for diabetes. Full article

Review

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24 pages, 2173 KiB  
Review
Everyday Lives of Middle-Aged Persons with Multimorbidity: A Mixed Methods Systematic Review
Int. J. Environ. Res. Public Health 2022, 19(1), 6; https://doi.org/10.3390/ijerph19010006 - 21 Dec 2021
Cited by 4 | Viewed by 3147
Abstract
The healthcare burden of patients with multimorbidity may negatively affect their family lives, leisure time and professional activities. This mixed methods systematic review synthesizes studies to assess how multimorbidity affects the everyday lives of middle-aged persons, and identifies skills and resources that may [...] Read more.
The healthcare burden of patients with multimorbidity may negatively affect their family lives, leisure time and professional activities. This mixed methods systematic review synthesizes studies to assess how multimorbidity affects the everyday lives of middle-aged persons, and identifies skills and resources that may help them overcome that burden. Two independent reviewers screened title/abstracts/full texts in seven databases, extracted data and used the Mixed Methods Appraisal Tool (MMAT) to assess risk of bias (RoB). We synthesized findings from 44 studies (49,519 patients) narratively and, where possible, quantitatively. Over half the studies provided insufficient information to assess representativeness or response bias. Two studies assessed global functioning, 15 examined physical functioning, 18 psychosocial functioning and 28 work functioning. Nineteen studies explored skills and resources that help people cope with multimorbidity. Middle-aged persons with multimorbidity have greater impairment in global, physical and psychosocial functioning, as well as lower employment rates and work productivity, than those without. Certain skills and resources help them cope with their everyday lives. To provide holistic and dynamic health care plans that meet the needs of middle-aged persons, health professionals need greater understanding of the experience of coping with multimorbidity and the associated healthcare burden. Full article
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12 pages, 570 KiB  
Review
Why Do People with Severe Mental Illness Have Poor Cardiovascular Health?—The Need for Implementing a Recovery-Based Self-Management Approach
Int. J. Environ. Res. Public Health 2021, 18(23), 12556; https://doi.org/10.3390/ijerph182312556 - 29 Nov 2021
Cited by 2 | Viewed by 2555
Abstract
People with severe mental illness (SMI) die significantly earlier than their well counterparts, mainly due to preventable chronic conditions such as cardiovascular disease (CVD). Based on the existing research, this perspective paper summarises the key contributors to CVD in people with SMI to [...] Read more.
People with severe mental illness (SMI) die significantly earlier than their well counterparts, mainly due to preventable chronic conditions such as cardiovascular disease (CVD). Based on the existing research, this perspective paper summarises the key contributors to CVD in people with SMI to better target the areas that require more attention to reduce, and ultimately resolve this health inequity. We discuss five broad factors that, according to current international evidence, are believed to be implicated in the development and maintenance of CVD in people with SMI: (1) bio-psychological and lifestyle-related factors; (2) socio-environmental factors; (3) health system-related factors; (4) service culture and practice-related factors; and (5) research-related gaps on how to improve the cardiovascular health of those with SMI. This perspective paper identifies that CVD in people with SMI is a multi-faceted problem involving a range of risk factors. Furthermore, existing chronic care or clinical recovery models alone are insufficient to address this complex problem, and none of these models have identified the significant roles that family caregivers play in improving a person’s self-management behaviours. A new framework is proposed to resolve this complex health issue that warrants a collaborative approach within and between different health and social care sectors. Full article
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