Intervention strategies that support self-care activities: an integrative study across disease/impairment groupings

BACKGROUND: The incidence of chronic disease and people with complex chronic medical needs is increasing worldwide. Self-care is an important element for these individuals and can pose challenges both to the recipients and providers of care. Health care professionals seeking evidence on how best to support self-care face challenges finding this research. As a care concept it is typically dealt with clinically and studied relative to specific conditions. The Cochrane Database of Systematic Reviews reports on research across 52 different disease/impairment groupings, with many systematic reviews presenting inconclusive results. Although individual reviews may not offer as much evidence as hoped, it is possible that by synthesizing evidence from multiple reviews that further knowledge and direction about the supportive care professionals can provide for self-care can be found and made available to inform practice. OBJECTIVE: To explore and evaluate the evidence on self-care interventions through a cross-cutting, integrative study. INCLUSION CRITERIA: Types of studies: All systematic reviews contained within the Cochrane Database of Systematic Reviews. TYPES OF PARTICIPANTS: Participants who were either recently diagnosed with, or currently living with, a disease, disability or impairment. No age stipulation was applied.Types of interventions: Interventions focused on initiating, supporting or enhancing self-care activities.Types of outcomes: The successful engagement of the individual in self-care activities; the sustainment of self-care activities; health outcomes or health care services utilization. SEARCH STRATEGIES: The search strategy was designed to find all systematic reviews contained within the Cochrane Database of Systematic Reviews that addressed interventions to initiate or enhance self-care. The Cochrane Library was searched directly though Wiley and through the OVID interface. Keywords and index terms were harvested from key reviews and a second round of searching was performed. METHODS OF THE REVIEW: Inclusion criteria: Inclusion criteria were guided by Orem's Theory of Self-Care. Reviews were included that addressed health deviation self-care requisites which refer to changes in self-care activities to regulate the effects of deviation from normal structure or function. INTERVENTIONS: Interventions were examined within the context of knowledge translation, using the Knowledge-to-Action framework by Graham and colleagues. Interventions were grouped into one of two sections in the framework: a) the adaptation to a specific population, or b) the sustainment of knowledge use. OUTCOMES: Outcomes were classified according to the Knowledge Use and Impact framework by Graham and colleagues. This framework categorizes outcomes in terms of what is being measured (knowledge; use of knowledge) as well as the impact of the use of that knowledge (patient/ individual; provider or system outcomes).Assessment of methodological quality: Methodological quality was assessed using the JBI Critical Appraisal Checklist for Systematic Reviews. A cut-off point of 7/10 was established. DATA EXTRACTION: Data were extracted from the systematic reviews using an adaptation of the standardized data extraction form, the JBI Data Extraction Form for Systematic Review of experimental/ Observational Studies. DATA SYNTHESIS: Study results were synthesized and discussed in narrative form. RESULTS: Thirty reviews were included in the analysis spanning 16 different disease/impairment groupings and representing a total of 91,170 participants. The most commonly reported intervention strategies were educational sessions (26 reviews) and self-care management plans (11 reviews), and 27 reviews assessed multiple intervention strategies. Twenty-one reviews reported statistically significant results. CONCLUSION: There is an emerging body of evidence for effective self-care. This study identified two strategies (educational sessions and self-care management plans) that could be used generically as supportive care by professionals as they assist individuals with self-care. IMPLICATIONS FOR PRACTICE: The use of multiple strategies, including educational sessions and self-care management plans have been identified as options that may be effective to support adoption and sustainment of self-care activities. IMPLICATIONS FOR RESEARCH: This study highlighted the pervasive problem of heterogeneous data at the primary research level preventing the effective synthesis of current evidence. Further research to standardize the type of outcome measured and the method of measurement would advance our ability to determine 'best practices' with self-care. Cochrane systematic review authors reported their systematic review methodologies in varying degrees of detail. Also of note was the range of different methods to assess risk of bias.

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