Building the Evidence Base for Chronic Disease Self-management Support Interventions Across Canada

Abstract

elf-management support (SMS) interventions are proliferating across Canada. They aim to decrease the growing burden of chronic diseases on individuals, families, communities and the health system. Their goal is empowered patients with the skills and confidence to better manage their conditions. 1 Many measures of effectiveness are used across SMS programs, 2 making comparisons difficult. Additionally, SMS is patient-centred and community-oriented, and must acknowledge the unique socioecological context in which disease management and support programs occur. 3 The purpose of this project was to determine how to improve evaluation of SMS in Canada to generate high-quality evidence to guide policy-makers, implementers, providers and participants. METHODSThis project used an iterative, multi-methods approach including scoping and focused literature reviews, internet scan, systematic review, interviews, a review of existing evaluation and chronic disease management frameworks, and a meeting of experts. The project was approved by the Ottawa Hospital Research Ethics Board. Scoping reviewA scoping review of the international literature identified the range of approaches to evaluation of SMS interventions. This review built on a 2008 systematic review 4 of chronic disease self-management interventions conducted by team members, searching multiple databases and grey literature sources for additional reports or discussions of evaluation methods until 2010. The scoping review methods are listed in Table 1. Seventy-eight studies or reports (see Supplemental Appendix A) met inclusion criteria, and evaluation methods and reported outcomes were identified for each of these. Systematic reviewA systematic review was conducted to identify SMS interventions reported for Canadian populations. Medline was used in order to capture the most mainstream articles from 2005 until July 7, 2012. The review methods are listed in Table 2.A total of 289 articles were returned by the search, after removing duplicates. Abstracts were reviewed to apply the inclusion and exclusion criteria and 20 articles received full review. Sixteen articles were included in a narrative synthesis of population, intervention, evaluation methods, and reported outcomes (see Supplemental Appendix B).

A randomized controlled trial of a combined self-management and exercise intervention for elderly people with osteoarthritis of the knee: the PLE2NO program

“…3,4 Self-management programs are committed to empowering individuals to cope with the disease and live better quality lives with fewer restrictions due to their illness. 5 However, the benefits in people with osteoarthritis are not clear. 6 The effects of combined exercise and self-management interventions have shown reduced pain and improved functions in patients with osteoarthritis, although many of the reviewed studies have methodological flaws, such as low statistical power, limited blinding and randomization procedures, and protracted treatment regimens.…”

An integrative literature review to examine the provision of self‐management support following transient ischaemic attack

“…Given the lack of consistent outcome measures among the studies in this review, use of outcomes based on a common evaluation framework in future research would assist with comparison of programmes (Johnston et al . ).…”

An environmental scan of policies in support of chronic disease self-management in Canada

“…To date, there is still very little published evidence that describes the overall reach of SMS programs in all provinces. 52 Future research examining the association of policy and program reach and effect in self-management of chronic diseases is needed.…”