Self-management of non-communicable diseases in low- and middle-income countries: A scoping review

Abstract

Background The prevalence of non-communicable diseases (NCDs) is rising in low- and middle-income countries (LMICs). Self-management, which enables patients to better manage their health, presents a potentially-scalable means of mitigating the growing burden of NCDs in LMICs. Though the effectiveness of self-management interventions in high-income countries is well-documented, the use of these strategies in LMICs has yet to be thoroughly summarized. Objective The purpose of this scoping review is to summarize the nature and effectiveness of past interventions that have enabled the self-management of NCDs in LMICs. Methods Using the scoping review methodology proposed by Arksey and O’Malley, PubMed was searched for relevant articles published between January 2007 and December 2018. The implemented search strategy comprised three major themes: self-management, NCDs and LMICs. Results Thirty-six original research articles were selected for inclusion. The selected studies largely focused on the self-management of diabetes (N = 21), hypertension (N = 7) and heart failure (N = 5). Most interventions involved the use of short message service (SMS, N = 17) or phone calls (N = 12), while others incorporated educational sessions (N = 10) or the deployment of medical devices (N = 4). The interventions were generally effective and often led to improvements in physiologic indicators, patient self-care and/or patient quality of life. However, the studies emphasized results in small populations, with little indication of future scaling of the intervention. Furthermore, the results indicate a need for further research into the self-management of cardiovascular diseases, as well as for the co-management of diabetes and cardiovascular disease. Conclusions Self-management appears to be an effective means of improving health outcomes in LMICs. Future strategies should include patients and clinicians in all stages of design and development, allowing for a focus on long-term sustainability, scalability and interoperability of the intervention in the target setting.

A Syndemic Perspective on the Management of Non-communicable Diseases Amid the COVID-19 Pandemic in Low- and Middle-Income Countries

“…Providing information on self-management behavior changes for NCDs and COVID-19 through SMS and social media platforms is an important step. In this situation, health literacy (having the necessary information and skills to manage health) and activation (motivation and the ability to take action) can play an important role ( 37 , 38 ) in self-management ( 39 ) of conditions among PLWNCDs in LMICs. Promoting both the health literacy and empowerment of PLWNCDs would enable patients to navigate health services, use technology to contact healthcare providers, develop problem-solving skills, and adhere to healthy lifestyle behaviors ( 40 ).…”

A Narrative Review of the Patient Journey Through the Lens of Non-communicable Diseases in Low- and Middle-Income Countries

“…Patients living with NCDs (PLWNCDs) have direct, extensive experience of living with the disease and understand first-hand the impact of the disease on their quality of life and physical function. Chronically ill patients are expected to participate substantially through self-care in managing their adherence to therapy and the safe use of prescribed medicines based on labelling and other information provided to them [ 17 ].…”

Segmentation of health-care consumers: psychological determinants of subjective health and other person-related variables

“…Persons with a low level of perceived control (segments 2 and 4) feel that they are 'victims' of their situation and dependent on others and circumstances and are less able to manage their own situation. They need help with planning and personal guidance, and even hope for a better future (segment 4to improve self-efficacy health [53], and selfmanagement behaviors for improving self-management [54]. People in segments 2 and 4 are very dissimilar: urban versus non-urban, high versus low social class, homeowner versus renter, high versus low income, religious versus nonreligious, respectively.…”