Elsevier

The Lancet

Volume 364, Issue 9444, 23–29 October 2004, Pages 1523-1537
The Lancet

Seminar
Self-management interventions for chronic illness

https://doi.org/10.1016/S0140-6736(04)17277-2Get rights and content

Summary

An increasing number of interventions have been developed for patients to better manage their chronic illnesses. They are characterised by substantial responsibility taken by patients, and are commonly referred to as self-management interventions. We examine the background, content, and efficacy of such interventions for type 2 diabetes, arthritis, and asthma. Although the content and intensity of the programmes were affected by the objectives of management of the illness, the interventions differed substantially even within the three illnesses. When comparing across conditions, it is important to recognise the different objectives of the interventions and the complexity of the issues that they are attempting to tackle. For both diabetes and asthma, the objectives are concerned with the underlying control of the condition with clear strategies to achieve the desired outcome. By contrast, strategies to deal with symptoms of pain and the consequences of disability in arthritis can be more complex. The interventions that were efficacious provide some guidance as to the components needed in future programmes to achieve the best results. But to ensure that these results endure over time remains an important issue for self-management interventions.

Section snippets

Differences between interventions

We identified 21 studies for type 2 diabetes,43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63 24 for arthritis (15 for rheumatoid arthritis,64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78 five for osteoarthritis,79, 80, 81, 82, 83 and four for both types of arthritis84, 85, 86, 87), and 18 for asthma.73, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109 SMIs for diabetes, arthritis, and asthma differed

Discussion

The SMIs for each of the three illnesses conditions in this review have general differences in content, which seem to result from the different objectives for management of each illness. Some of the studies for asthma attempted to halt development of symptoms, whereas those for arthritis tended to try to reduce the effect of the symptoms and illness, and therefore tended to have broader focus. For diabetes, many of the studies were concerned with aspects of integration of the complex regimen

Search strategy and selection criteria

We searched MEDLINE, PsycINFO, and Embase (1997–2002) for each illness. Search terms were: (“diabetes”) or (“asthma”) or (“arthritis” or “osteoarthritis” or “musculoskeletal” or “rheum*”) and (“self-management” or “self-care” or “education*” or “behav*” or “psych*” or “cognitive”) and (“intervention” or “program*” or “trial”) and (“random*” or “RCT”). Studies were included if (1) the study assessed an SMI: interventions that only provided information in a didactic format or manipulated delivery

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