Department of Health Sciences, University of York, York, United Kingdom.
Hull York Medical School, York, United Kingdom.
PLoS One. 2021 Oct 26;16(10):e0258937. doi: 10.1371/journal.pone.0258937. eCollection 2021.
People living with severe mental illness (SMI) have a reduced life expectancy by around 15-20 years, in part due to higher rates of long-term conditions (LTCs) such as diabetes and heart disease. Evidence suggests that people with SMI experience difficulties managing their physical health. Little is known, however, about the barriers, facilitators and strategies for self-management of LTCs for people with SMI.
To systematically review and synthesise the qualitative evidence exploring facilitators, barriers and strategies for self-management of physical health in adults with SMI, both with and without long-term conditions.
CINAHL, Conference Proceedings Citation Index- Science, HMIC, Medline, NICE Evidence and PsycInfo were searched to identify qualitative studies that explored barriers, facilitators and strategies for self-management in adults with SMI (with or without co-morbid LTCs). Articles were screened independently by two independent reviewers. Eligible studies were purposively sampled for synthesis according to the richness and relevance of data, and thematically synthesised.
Seventy-four articles met the inclusion criteria for the review; 25 articles, reporting findings from 21 studies, were included in the synthesis. Seven studies focused on co-morbid LTC self-management for people with SMI, with the remaining articles exploring self-management in general. Six analytic themes and 28 sub-themes were identified from the synthesis. The themes included: the burden of SMI; living with co-morbidities; beliefs and attitudes about self-management; support from others for self-management; social and environmental factors; and routine, structure and planning.
The synthesis identified a range of barriers and facilitators to self-management, including the burden of living with SMI, social support, attitudes towards self-management and access to resources. To adequately support people with SMI with co-morbid LTCs, healthcare professionals need to account for how barriers and facilitators to self-management are influenced by SMI, and meet the unique needs of this population.
患有严重精神疾病（SMI）的人预期寿命缩短约 15-20 年，部分原因是糖尿病和心脏病等长期疾病（LTCs）的发病率较高。有证据表明，患有 SMI 的人在管理身体健康方面存在困难。然而，对于患有 SMI 的人管理 LTCs 的障碍、促进因素和策略知之甚少。
系统回顾和综合分析探索患有 SMI 的成年人（无论是否患有长期疾病）管理身体健康的促进因素、障碍和策略的定性证据。
CINAHL、会议论文引文索引-科学、HMIC、Medline、NICE 证据和 PsycInfo 进行了搜索，以确定探索患有 SMI 的成年人（无论是否患有合并 LTC）自我管理障碍、促进因素和策略的定性研究。文章由两名独立审查员独立筛选。根据数据的丰富性和相关性，对符合条件的研究进行有针对性的抽样，进行主题综合。
74 篇文章符合本综述的纳入标准；25 篇文章，来自 21 项研究的结果，被纳入综合分析。有 7 项研究侧重于患有 SMI 的合并 LTC 自我管理，其余文章则探索了一般的自我管理。从综合分析中确定了六个分析主题和 28 个子主题。这些主题包括：SMI 的负担；合并症的生活；对自我管理的信念和态度；他人对自我管理的支持；社会和环境因素；以及常规、结构和规划。
综合分析确定了自我管理的一系列障碍和促进因素，包括患有 SMI 的负担、社会支持、对自我管理的态度和获取资源的机会。为了充分支持患有合并 LTC 的 SMI 患者，医疗保健专业人员需要考虑到自我管理的障碍和促进因素如何受到 SMI 的影响，并满足这一人群的独特需求。
