What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Lifestyle-related chronic disease (n=5681). Intervention: Self-management programs vs. Usual care, no treatment, or active control (health education, group exercise, mindful eating). Primary outcome: Physical activity (SMD 0.25, 95% CI 0.16-0.34).

July 23, 2021Open Access

Effects of self-management programs on behavioral modification among individuals with chronic disease: A systematic review and meta-analysis of randomized trials

SKSun Ju KimSejong General Hospital MPMoonkyoung ParkDaejeon University RSRhayun SongChungnam National University

Key Result

Self-management programs produced small but significant improvements in physical activity (SMD 0.25), dietary habits (SMD 0.28), and health responsibility (SMD 0.18) among adults with lifestyle-related chronic disease.

Study Design

Type

Meta-Analysis (n=5,681)

Structured PICO

Do self-management programs improve behavioral modifications such as physical activity, dietary habits, health responsibility, stress management, and smoking in adults with lifestyle-related chronic diseases?

Population

5,681 adults (≥18 years old) with lifestyle-related chronic diseases and modifiable cardiovascular risk factors (including diabetes, hypertension, hyperlipidemia, obesity, metabolic syndrome, and cardiovascular disease) pooled from 25 randomized controlled trials.

Intervention

Self-management programs (SMPs) focusing on behavioral modifications and self-management strategies, delivered individually or in groups by experts or peers, with durations ranging from 3 days to 12 months.

Comparator

Usual care, no treatment, health education, motivational interviewing, group-based exercise, or mindful eating.

Outcome

Behavioral modifications including physical activity, dietary habits, health responsibility, stress management, and smoking-related behavior.patient reported

Self-management programs provide small but significant improvements in physical activity, dietary habits, and health responsibility among patients with lifestyle-related chronic diseases.

Main Result

Effect estimate: SMD 0.25 (95% CI 0.16-0.34)

Limitations

Examined effects immediately after interventions and did not include follow-up data to assess long-term retention
Only included studies published in English and Korean, which may reduce generalizability
Relatively few randomized studies were available that analyzed stress management and smoking-related behaviors

Abstract

The prevalence of chronic disease associated with unhealthy lifestyles has been increasing worldwide. Health professionals have recognized that self-management programs (SMPs) can provide health benefits by promoting health behaviors, especially when applied to individuals with lifestyle-related chronic disease. This review performed a meta-analysis of the features of SMPs using randomized studies and analyzed the magnitude of the combined effects of self-management on behavioral modification. We searched the PubMed, CINAHL, ScienceDirect, SCOPUS, Web of Science, Embase, Cochrane Library, DBpia, and KISS to identify randomized trials that evaluated the behavioral outcomes of SMPs. Subgroup analyses were performed for program duration, providers, type of comparisons, and program settings. We selected 25 studies (N = 5,681) to perform analyses with random-effects models. The effect sizes of SMPs were small but significant for physical activity (standardized difference in means SDM = 0.25), dietary habits (SDM = 0.28), and health responsibility (SDM = 0.18), and not significant for stress management and smoking behaviors. A short-term SMPs (less than 12 weeks) was indicated as being effective in modifying physical activity, dietary habits, and health responsibility, while the program effects on dietary habits were significant only with expert-delivered education and when compared with inactive controls. The findings of this study indicate that SMPs can effectively improve physical activity, dietary habits, and health responsibility in individuals with chronic disease, with a small but significant effect size. Future studies should explore the effects of SMPs on stress management and smoking cessation and assess the long-term maintenance of healthy lifestyles in individuals with lifestyle-related chronic disease.

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