The accessibility and acceptability of self-management support interventions for men with long term conditions: a systematic review and meta-synthesis of qualitative studies

Abstract

BackgroundSelf-management support interventions can improve health outcomes, but their impact is limited by the numbers of people able or willing to access them. Men’s attendance at existing self-management support services appears suboptimal despite their increased risk of developing many of the most serious long term conditions. The aim of this review was to determine whether current self-management support interventions are acceptable and accessible to men with long term conditions, and explore what may act as facilitators and barriers to access of interventions and support activities.MethodsA systematic search for qualitative research was undertaken on CINAHL, EMBASE, MEDLINE, PsycINFO and Social Science Citation Index, in July 2013. Reference lists of relevant articles were also examined. Studies that used a qualitative design to explore men’s experiences of, or perceptions towards, self-management support for one or more long term condition were included. Studies which focused on experiences of living with a long term condition without consideration of self-management support were excluded. Thirty-eight studies met the inclusion criteria. A meta-ethnography approach was employed to synthesise the findings.ResultsFour constructs associated with men’s experience of, and perceptions towards, self-management support were identified: 1) need for purpose; 2) trusted environments; 3) value of peers; and 4) becoming an expert. The synthesis showed that men may feel less comfortable participating in self-management support if it is viewed as incongruous with valued aspects of their identity, particularly when activities are perceived to challenge masculine ideals associated with independence, stoicism, and control. Men may find self-management support more attractive when it is perceived as action-oriented, having a clear purpose, and offering personally meaningful information and practical strategies that can be integrated into daily life.ConclusionsSelf-management support is most likely to be successful in engaging men when it is congruent with key aspects of their masculine identity. In order to overcome barriers to access and fully engage with interventions, some men may need self-management support interventions to be delivered in an environment that offers a sense of shared understanding, connectedness, and normality, and involves and/or is facilitated by men with a shared illness experience.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1230) contains supplementary material, which is available to authorized users.

Coping Strategies, Psychological Impact, and Support Preferences of Men With Rheumatoid Arthritis: A Multicenter Survey

“…This reflects the current provision of care, but men were also interested in a question‐and‐answer session with their rheumatologist or specialist nurse, opportunities to hear about current research, and education sessions for symptom management. This is similar to evidence from studies of other long‐term conditions suggesting that support services for men should have a practical focus 16 and provide opportunities to gather new information 22, 23 and that men use information exchange as a form of emotional support 24. Despite this finding, men are underrepresented in trials focusing on symptom management in RA (e.g., in a fatigue management program, 85.4% of the participants were female) 25.…”

“…Male participants were less interested than women in hearing from other RA patients, which may reflect men's preferences for seeking out information rather than experiences 16. Although this may call into question the appropriateness of providing interventions involving co‐delivery with patients for men, previous qualitative work found that co‐facilitation by a patient research partner in focus groups was helpful for engaging men in discussion 8.…”

Cancer survivors’ perspectives on adjustment-focused self-management interventions: a qualitative meta-synthesis

“…Self-management interventions focus on enhancing patients' ability and 5 confidence to manage their condition effectively by providing education, training and support to develop their 6 knowledge, skills and both internal and external resources [3]. They have been developed for a range of different 7 long-term conditions and can take a variety of forms (e.g., lay or professionally led, generic or disease-specific,…”

“…Despite these potential benefits, significant gaps remain in understanding which aspects 15 of self-management interventions work best, in what circumstances, and for whom [3,10]. A substantial…”

“…Finally, it was found that some participants did not engage with self-management interventions, as they felt that 12 they were receiving enough support from family and friends or were successfully managing the impact of their around what constitutes a self-management intervention made the study selection process difficult; this was 7 further exacerbated by the fact that interventions promoting self-management are often not referred to explicitly 8 as such [3]. Another factor that hindered our literature search was the poor labelling of qualitative studies in 9 research databases [53].…”