Self-management interventions for common long-term conditions in low- and middle-income countries: a synthesis of current evidence.

BACKGROUND

In addition to endemic communicable diseases, resource-poor health systems in low- and middle-income countries (LMICs) are buckling under an increasing prevalence, morbidity, and mortality attributable to non-communicable diseases (NCD) - 'NCDs crisis.' Supported self-management (SM) is a recommended approach for improving patient outcomes. There is yet no robust evidence on the effectiveness of SM interventions for people with long-term conditions (LTCs) in LMICs.

METHODS

Underpinned by a comprehensive search of seven databases, we conducted a systematic review and evidence synthesis. Paired reviewers completed study selection, methodological, and data extraction. Here, we report a synthesis considering disease-specific (e.g. glycated haemoglobin (HbA1c), quality-of-life (QoL), and economic outcomes.

RESULTS

Of 49 222 citations, 26 studies were included in the analysis (one systematic review, 14 trials, five cross-sectional, and six qualitative studies). LTCs for which SM interventions were reported included: diabetes (14 studies, n = 2388), hypertension (six studies, n = 1779), and arthritis (two studies, n = 180). Further, three studies (n = 237) were on co-morbid diabetes and hypertension. Interventions were broadly classified as: SM education, mobile health-guided SM, and community-based support for SM. Education on SM showed the most promising improvement in clinical outcomes (e.g. mean pain intensity scores from 3.97 to 2.77), functional ability, HbA1c (pre-intervention mean of 8.58% to a post-intervention 8.08% in one study; 9.45% to 8.98% in another study), millimetres of mercury (mmHg) (pre-intervention mean of 129.7/83.7 to a post-intervention 117.9/75.3) and health-related QoL (e.g. EuroQol Five Dimension score improvement from 0.77 to 0.89 post-intervention) among patients living with diabetes, hypertension and arthritis compared to usual care. Effectiveness of interventions was dependent on literacy, SM education delivery aids, and disease-specific care, as patients preferred in-person (interactive) education sessions over virtual assistance alone.

CONCLUSION

Guided SM interventions with community-based support show promise for improving outcomes for people with common LTCs in LMICs. However, a dearth of cost-feasibility data and variability in outcomes limit decisions on scalability and policy decision making. There is a need for regulatory bodies to develop clinical guidelines and promote implementation of tailored SM education as a core management strategy for LTCs care in LMICs.

REGISTRATION

PROSPERO CRD42022345762.