Ingram School of Nursing, McGill University, Quebec, Montreal, Canada.
St. Mary's Research Centre, Quebec, Montreal, Canada.
J Gen Intern Med. 2018 Apr;33(4):510-523. doi: 10.1007/s11606-017-4265-x. Epub 2018 Feb 9.
With the burden of chronic illness increasing globally, self-management is a crucial strategy in reducing healthcare costs and increasing patient quality of life. Low income and low health literacy are both associated with poorer health outcomes and higher rates of chronic disease. Thus, self-management represents an important healthcare strategy for these populations. The purpose of this study is to review self-management interventions in populations with low income or low health literacy and synthesize the efficacy of these interventions.
A systematic review of trials evaluating the efficacy of self-management interventions in populations with low income or low health literacy diagnosed with a chronic illness was conducted. Electronic databases were primarily searched to identify eligible studies. Data were extracted and efficacy summarized by self-management skills, outcomes, and content tailoring.
23 studies were reviewed, with ten reporting an overall positive effect on at least one primary outcome. Effective interventions most often included problem-solving as well as taking action and/or resource utilization. A wide range of health-related outcomes were considered, were efficacious empowerment and disease-specific quality of life were found to be significant. The efficacy of interventions did not seem to vary by duration, format, or mode of delivery or whether these included individuals with low health literacy and/or low income. Tailoring did not seem to impact on efficacy.
Findings suggest that self-management interventions in populations with low income or low health literacy are most effective when three to four self-management skills are utilized, particularly when problem-solving is targeted. Healthcare providers and researchers can use these findings to develop education strategies and tools for populations with low income or low health literacy to improve chronic illness self-management.
随着全球慢性病负担的增加，自我管理是降低医疗成本和提高患者生活质量的关键策略。低收入和低健康素养与较差的健康结果和较高的慢性病发病率有关。因此，自我管理是这些人群的重要医疗策略。本研究旨在综述低收入或低健康素养人群的自我管理干预措施，并综合评估这些干预措施的疗效。
系统检索评估低收入或低健康素养人群（患有慢性病）自我管理干预措施疗效的试验。主要检索电子数据库以确定合格的研究。通过自我管理技能、结果和内容调整来提取和总结疗效。
共回顾了 23 项研究，其中 10 项研究报告了至少一项主要结局的总体积极效果。有效的干预措施通常包括解决问题以及采取行动和/或利用资源。考虑了广泛的与健康相关的结果，发现有效的干预措施可以显著提高赋权和疾病特异性生活质量。干预措施的疗效似乎不受持续时间、格式或传递模式的影响，也不受是否包括低健康素养和/或低收入个体的影响。调整似乎不会影响疗效。
研究结果表明，当使用三到四项自我管理技能时，低收入或低健康素养人群的自我管理干预措施最为有效，特别是当针对解决问题时。医疗保健提供者和研究人员可以利用这些发现为低收入或低健康素养人群制定教育策略和工具，以改善慢性病自我管理。
