Impact of Behavioral Interventions on Patient Activation in Adults with Hypertension: A Systematic Review and Meta-Analysis

Abstract

Introduction: Behavioral interventions assist patients in maintaining optimal self-management of their health, especially in those at risk of certain conditions. Little is known about the effects of self-management interventions on patient activation in adults with hypertension. Therefore, this systematic review and meta-analysis aimed to evaluate how self-management strategies affect changes in activation levels in adults with hypertension. Methods: We searched online databases: PubMed, CINAHL, and Cochrane Central Register of Controlled Trials for studies published between January 2004 and May 2021. We included randomized controlled trials that assessed the effects of self-management interventions on patient activation in adults with hypertension and reported patient activation using the patient activation measure (PAM). Results: 4 Four studies (N = 1415 participants) met the inclusion criteria. In adults with hypertension, self-management interventions improved patient activation with moderate strength of evidence. A community-based self-management program, motivational interviewing strategies, and home-based patient-activated care were associated with better PAM scores than usual care. Conclusion: Our findings reinforce the need for healthcare providers to incorporate these interventions into primary care to support the adoption of recommended hypertension self-management behaviors. Future studies must focus on tailoring support to the patient’s level of activation in hypertension self-management.

Patient activation, adherence to hypertension treatment plans and blood pressure control in Saudi Arabia: a cross-sectional study

“…Innab and Kerari conducted a systematic review and meta-analysis aimed to evaluate how self-management strategies affect changes in activation levels in adults with hypertension. 28 As a result, the authors only found four randomised controlled trials that assessed the effects of self-management interventions on patient activation in adults with hypertension. Self-management interventions (ie, community-based self-management programmes, motivational interviewing strategies) were associated with better PAM scores and BP control than usual care.…”

“…Self-management interventions (ie, community-based self-management programmes, motivational interviewing strategies) were associated with better PAM scores and BP control than usual care. 28 More research needs to be conducted aimed at evaluating the impact of patient activation on chronic disease self-management in Middle Eastern countries. In the context of hypertension disease, targeted strategies tailored to individual levels of activation are needed to improve self-management skills.…”

“…Thus, it is difficult to explain the reasons for the findings found in this study. Innab and Kerari conducted a systematic review and meta-analysis aimed to evaluate how self-management strategies affect changes in activation levels in adults with hypertension 28. As a result, the authors only found four randomised controlled trials that assessed the effects of self-management interventions on patient activation in adults with hypertension.…”

“…As a result, the authors only found four randomised controlled trials that assessed the effects of self-management interventions on patient activation in adults with hypertension. Self-management interventions (ie, community-based self-management programmes, motivational interviewing strategies) were associated with better PAM scores and BP control than usual care 28. More research needs to be conducted aimed at evaluating the impact of patient activation on chronic disease self-management in Middle Eastern countries.…”

Evaluating the impact of patient-reported outcome measures on depression and anxiety levels in people with multiple sclerosis: a study protocol for a randomized controlled trial

“…Cross-sectional analyses in primary care have demonstrated increased patient activation as associated with reduced probability of ED visits, hospitalization, obesity, and smoking, along with increased likelihood of up to date status of age-appropriate cancer screening, normal blood pressure, and lipid laboratory markers [ 48 ]. Patient engagement is feasible, effective, and relevant in chronic medical conditions such as hypertension [ 49 ], diabetes [ 50 ], and heart failure [ 51 ]. In PwMS, higher patient activation is associated with improved depressive symptoms, quality of life, self-efficacy, and fatigue [ 46 , 52 , 53 ] as well as greater confidence in selecting disease modifying therapies in partnership with their MS healthcare providers [ 54 ].…”