La Trobe University Rural Health School, 471 Benetook Avenue, Mildura, Victoria, 3500, Australia.
Sunraysia Community Health Services, 137 Thirteenth Street, Mildura, Victoria, 3500, Australia.
BMC Health Serv Res. 2020 Feb 27;20(1):150. doi: 10.1186/s12913-020-5010-4.
The social gradient in chronic disease (CD) is well-documented, and the ability to effectively self-manage is crucial to reducing morbidity and mortality from CD. This systematic review aimed to assess the moderating effect of socioeconomic status on self-management support (SMS) interventions in relation to participation, retention and post-intervention outcomes.
Six databases were searched for studies of any design published until December 2018. Eligible studies reported on outcomes from SMS interventions for adults with chronic disease, where socioeconomic status was recorded and a between-groups comparison on SES was made. Possible outcomes were participation rates, retention rates and clinical or behavioural post-intervention results.
Nineteen studies were retrieved, including five studies on participation, five on attrition and nine studies reporting on outcomes following SMS intervention. All participation studies reported reduced engagement in low SES cohorts. Studies assessing retention and post-intervention outcomes had variable results, related to the diversity of interventions. A reduction in health disparity was seen in longer interventions that were individually tailored. Most studies did not provide a theoretical justification for the intervention being investigated, although four studies referred to Bandura's concept of self-efficacy.
The limited research suggests that socioeconomic status does moderate the efficacy of SMS interventions, such that without careful tailoring and direct targeting of barriers to self-management, SMS may exacerbate the social gradient in chronic disease outcomes. Screening for patient disadvantage or workload, rather than simply recording SES, may increase the chances of tailored interventions being directed to those most likely to benefit from them. Future interventions for low SES populations should consider focussing more on treatment burden and patient capacity.
PROSPERO registration CRD42019124760. Registration date 17/4/19.
慢性疾病（CD）的社会梯度是有据可查的，而有效自我管理对于降低 CD 的发病率和死亡率至关重要。本系统评价旨在评估社会经济地位对自我管理支持（SMS）干预在参与度、保留率和干预后结果方面的调节作用。
检索了截至 2018 年 12 月的六个数据库中任何设计的研究。合格的研究报告了针对慢性疾病成人的 SMS 干预的结果，其中记录了社会经济地位，并对 SES 进行了组间比较。可能的结果是参与率、保留率和临床或行为干预后结果。
共检索到 19 项研究，其中 5 项研究参与度、5 项研究失访率和 9 项研究报告 SMS 干预后的结果。所有参与度研究都报告称，SES 较低的队列参与度降低。评估保留率和干预后结果的研究结果各不相同，这与干预措施的多样性有关。在时间较长且针对个体的干预措施中，健康差距有所缩小。大多数研究没有为正在研究的干预措施提供理论依据，尽管有四项研究提到了班杜拉的自我效能概念。
有限的研究表明，社会经济地位确实调节了 SMS 干预的效果，因此，如果不仔细调整和直接针对自我管理的障碍，SMS 可能会加剧慢性疾病结果的社会梯度。对患者劣势或工作量进行筛查，而不仅仅是记录 SES，可能会增加针对最有可能从中受益的患者进行定制干预的机会。针对 SES 较低人群的未来干预措施应更多地关注治疗负担和患者能力。
PROSPERO 注册 CRD42019124760。注册日期为 19 年 4 月 17 日。
