Intervention Components Targeting Self-Management in Individuals with Multiple Chronic Conditions: An Integrative Review

Abstract

Multiple chronic conditions (MCC) are becoming increasingly common and self-management (SM) interventions to address MCC are emerging. Prior reviews have broadly examined SM interventions in MCC; however, interventional components were not thoroughly described. Components of SM interventions that have been delivered to individuals with MCC were identified. A review of CINAHL, Cochrane, PubMed, PsycINFO, Scopus, and Embase was completed. This search yielded 13,994 potential studies; 31 studies among those 13,994 studies met inclusion for analysis. The literature is multidisciplinary and describes a wide variety of interventional strategies implementing various combinations of components. A descriptive analysis of the studies’ components, application of the components, delivery methods, and primary outcomes demonstrated clear variations between programs. The most common components noted in the 31 studies were education, action planning/goal setting, self-monitoring, and social/peer support. The variation in SM programs limits conclusive evidence for which components are recommended to improve self-management in individuals with MCC.

A scoping review of person and family engagement in the context of multiple chronic conditions

“…No date criteria were used in our search strategy, but all six reviews were published after 2015. Methods varied as follows: one review identified itself as a systematic review, 30 two as narrative reviews, 31,32 one as a systematic scoping review, 33 one as a thematic analysis review, and one as an integrative review 34 . The six review articles included 81 unique studies describing 47 unique interventions and 26 unique observational studies, 4 reviews, and 4 studies with mixed methodology.…”

“… 33 Another review focused on interventions involving individuals with MCCs in decision making, 30 and four reviews focused on self‐management among those with MCC. Of the four reviews of self‐management, two described characteristics and challenges of self‐management, 31,35 one described the assessment of self‐management, 35 and one focused on self‐management interventions 34 . The two reviews of qualitative literature of challenges in self‐management of MCC identified the tendency of individuals with MCC to prioritize a dominant illness among multiple diagnoses, with a variety of processes underpinning this prioritization (and re‐prioritization) such as the chronological order of diagnoses, perceived contribution of one disease to quality of life or survival, or condition with an unpredictable course 31,35 .…”

“…Three of 21 discrete interventions in Daniel's review explicitly targeted family/friends; the other reviews did not address family/friends explicitly. Miller et al 34 identified the most common elements of self‐management interventions for persons with MCCs in 31 studies, finding that education was most common (present in 31/31 included studies), followed by action planning/goal setting, self‐monitoring, and social/peer support (in 6 of 31) studies. Just one of the reviews on interventions (by Butterworth et al 30 ) used a standardized checklist (the Template for Intervention Description and Replication [TIDieR] checklist) 36 to organize findings.…”

“…Daniel identified 27 outcomes such as patient empowerment/activation, quality of life, quality of care, physiologic measures, treatment adherence, services use, and clinician satisfaction 33 . Miller examined primary outcomes only and identified 13 categories of outcomes including disease‐specific outcomes, general health outcomes, and self‐management behaviors 34 . Butterworth identified 14 outcomes in 7 categories that spanned such categories as involvement in decision making, enablement and engagement, health status, patient evaluation of care, treatment burden, resource use and costs, and patient and caregiver experiences 30 .…”

“…33 Miller examined primary outcomes only and identified 13 categories of outcomes including disease-specific outcomes, general health outcomes, and self-management behaviors. 34 Butterworth identified 14 outcomes in 7 categories that spanned such categories as involvement in decision making, enablement and engagement, health status, patient evaluation of care, treatment burden, resource use and costs, and patient and caregiver experiences. 30 Only Butterworth sought to synthesize results of the relationship between engagement-related interventions and outcomes.…”