Akhal Taim, Gabra Margherita, Adesokan Miriam, Babatunde Opeyemi O
The West African Institute for Applied Health Research (WAFERs), Ibadan, Oyo State, Nigeria.
Keele University, School of Medicine, Keele, Newcastle-under-Lyme, Staffordshire, UK.
J Glob Health. 2025 May 23;15:04148. doi: 10.7189/jogh.15.04148.
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.
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.
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.
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.
PROSPERO CRD42022345762.
除了地方性传染病外，低收入和中等收入国家（LMICs）资源匮乏的卫生系统正因非传染性疾病（NCD）导致的患病率、发病率和死亡率不断上升而不堪重负——即“非传染性疾病危机”。支持性自我管理（SM）是一种推荐的改善患者预后的方法。目前尚无有力证据表明SM干预措施对LMICs中患有长期疾病（LTCs）的人群有效。
在对七个数据库进行全面检索的基础上，我们进行了系统评价和证据综合分析。由两名评审员共同完成研究筛选、方法学评估和数据提取。在此，我们报告一项综合分析，考虑了疾病特异性（如糖化血红蛋白（HbA1c）、生活质量（QoL）和经济结果）。
在49222条文献中，26项研究被纳入分析（1项系统评价、14项试验、5项横断面研究和6项定性研究）。报告了SM干预措施的LTCs包括：糖尿病（14项研究，n = 2388）、高血压（6项研究，n = 1779）和关节炎（2项研究，n = 180）。此外，3项研究（n = 237）涉及糖尿病和高血压合并症。干预措施大致分为：SM教育、移动健康指导的SM以及基于社区的SM支持。与常规护理相比，SM教育在临床结果（如平均疼痛强度评分从3.97降至2.77）、功能能力、HbA1c（一项研究中干预前平均为8.58%，干预后为8.08%；另一项研究中从9.45%降至8.98%）、毫米汞柱（mmHg）（干预前平均为129.7/83.7，干预后为117.9/75.3）以及与健康相关的QoL（如干预后欧洲五维健康量表评分从0.77提高到0.89）方面显示出最有希望的改善，这些改善发生在患有糖尿病、高血压和关节炎的患者中。干预措施的有效性取决于识字能力、SM教育辅助工具以及疾病特异性护理，因为患者更喜欢面对面（互动式）教育课程而非仅虚拟辅助。
在基于社区的支持下进行的指导性SM干预措施有望改善LMICs中患有常见LTCs人群的预后。然而，成本可行性数据的缺乏和结果的变异性限制了关于可扩展性和政策决策的决定。监管机构需要制定临床指南，并促进实施量身定制的SM教育，将其作为LMICs中LTCs护理的核心管理策略。
PROSPERO CRD42022345762
