Self-management interventions for common long-term conditions in low- and middle-income countries: a synthesis of current evidence.

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

Abstract

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 (NCD) - '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. Underpinned by a comprehensive search of seven databases, we conducted a systematic review and evidence synthesis. Paired reviewers completed study selection, methodological, and data extraction. Here, we report a synthesis considering disease-specific (e.g. glycated haemoglobin (HbA1c), quality-of-life (QoL), and economic outcomes. Of 49 222 citations, 26 studies were included in the analysis (one systematic review, 14 trials, five cross-sectional, and six qualitative studies). LTCs for which SM interventions were reported included: diabetes (14 studies, n = 2388), hypertension (six studies, n = 1779), and arthritis (two studies, n = 180). Further, 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 from 3.97 to 2.77), functional ability, HbA1c (pre-intervention mean of 8.58% to a post-intervention 8.08% in one study; 9.45% to 8.98% in another study), millimetres of mercury (mmHg) (pre-intervention mean of 129.7/83.7 to a post-intervention 117.9/75.3) and health-related QoL (e.g. EuroQol Five Dimension score improvement from 0.77 to 0.89 post-intervention) 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. 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. PROSPERO CRD42022345762. [Abstract copyright: Copyright © 2025 by the Journal of Global Health. All rights reserved.]

Citation

Akhal, T., Gabra, M., Adesokan, M., & Babatunde, O. O. (in press). Self-management interventions for common long-term conditions in low- and middle-income countries: a synthesis of current evidence. Journal of Global Health, 15(04148), https://doi.org/10.7189/jogh.15.04148

• Journal Article Type: Article
• Acceptance Date: May 23, 2025
• Online Publication Date: May 23, 2025
• Deposit Date: Jun 9, 2025
• Journal: Journal of global health
• Print ISSN: 2047-2978
• Electronic ISSN: 2047-2986
• Publisher: International Society of Global Health
• Peer Reviewed: Peer Reviewed
• Volume: 15
• Issue: 04148
• DOI: https://doi.org/10.7189/jogh.15.04148
• Keywords: Quality of Life, Humans, Self-Management - methods, Chronic Disease - therapy, Noncommunicable Diseases - therapy, Hypertension - therapy, Developing Countries
• Public URL: https://keele-repository.worktribe.com/output/1276780
• Publisher URL: https://jogh.org/2025/jogh-15-04148