Self-management Interventions for Common Long-term Conditions in Low- and Middle-income Countries

Akhal, Taim; Gabra, Margherita; Adesokan, Miriam; Babatunde, Opeyemi

Abstract

Background: In addition to endemic communicable diseases, resource-poor health systems in low- and middle-income countries (LMICs) are buckling under an increasing prevalence, morbidity, and mortality attributable to non-communicable diseases- “NCDs crisis”. Supported self-management (SM) is a recommended approach for improving patient outcomes. There is yet no robust evidence on the effectiveness of SM interventions for people with long-term conditions-LTCs in LMICs.

Methods: Underpinned by a comprehensive search of seven databases, a systematic review and evidence synthesis was conducted. Paired reviewers completed study selection, methodological appraisal (Mixed Method Appraisal Tool-MMAT) and data extraction. Data analysis was by a narrative synthesis considering disease-specific (e.g. HbA1c), quality-of-life (QoL) and economic outcomes.

Results: Of 49222 citations, 26 studies (1 systematic review, 14 trials, 5 cross-sectional and 6 qualitative) were included. LTCs for which SM interventions were reported included: diabetes (14 studies, N=2388), hypertension (6 studies, N=1779), and arthritis (2 studies, N=180). Three studies (N=237) were on co-morbid diabetes and hypertension. Interventions were broadly classified as: SM education, Mobile Health guided SM, and community-based support for SM. Education on SM showed the most promising improvement in clinical outcomes (e.g., mean pain intensity scores (3.97 to 2.77), functional ability, HbA1c (8.58 to 8.08%; 9.45 to 8.98%), mmHG (129.7/83.7 to 117.9/75.3) and health-related QoL (e.g. EQ-5D score improvement from 0.77 to 0.89) among patients living with diabetes, hypertension and arthritis compared to usual care. Effectiveness of interventions was dependent on literacy, SM education delivery aids, and disease-specific care as patients preferred in-person (interactive) education sessions over virtual assistance alone.

Conclusion: Guided SM interventions with community-based support show promise for improving outcomes for people with common LTCs in LMICs. However, a dearth of cost-feasibility data and variability in outcomes limit decisions on scalability and policy decision making. There is a need for regulatory bodies to develop clinical guidelines and promote implementation of tailored SM education as a core management strategy for LTCs care in LMICs.

Citation

Akhal, T., Gabra, M., Adesokan, M., & Babatunde, O. (in press). Self-management Interventions for Common Long-term Conditions in Low- and Middle-income Countries. Journal of Global Health,

• Journal Article Type: Article
• Acceptance Date: Jan 29, 2025
• Deposit Date: Apr 16, 2025
• Print ISSN: 2047-2978
• Electronic ISSN: 2047-2986
• Publisher: International Society of Global Health
• Peer Reviewed: Peer Reviewed
• Public URL: https://keele-repository.worktribe.com/output/1196744