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      The Effectiveness of Self-Management Interventions for Individuals with Low Health Literacy and/or Low Income: A Descriptive Systematic Review

      research-article
      , RN, BSc, MSc(N) 1 , , RN, BSc, MSc(N) 1 , , RN, BSc, MSc(N) 1 , , RN, BA, MSc(N) 1 , , MSc 2 , , MLIS 3 , , RN, BSc(N), PhD 1 , 2 ,
      Journal of General Internal Medicine
      Springer US
      self-management, chronic disease, disease management, vulnerable populations, health literacy

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          Abstract

          Background

          With the burden of chronic illness increasing globally, self-management is a crucial strategy in reducing healthcare costs and increasing patient quality of life. Low income and low health literacy are both associated with poorer health outcomes and higher rates of chronic disease. Thus, self-management represents an important healthcare strategy for these populations. The purpose of this study is to review self-management interventions in populations with low income or low health literacy and synthesize the efficacy of these interventions.

          Methods

          A systematic review of trials evaluating the efficacy of self-management interventions in populations with low income or low health literacy diagnosed with a chronic illness was conducted. Electronic databases were primarily searched to identify eligible studies. Data were extracted and efficacy summarized by self-management skills, outcomes, and content tailoring.

          Results

          23 studies were reviewed, with ten reporting an overall positive effect on at least one primary outcome. Effective interventions most often included problem-solving as well as taking action and/or resource utilization. A wide range of health-related outcomes were considered, were efficacious empowerment and disease-specific quality of life were found to be significant. The efficacy of interventions did not seem to vary by duration, format, or mode of delivery or whether these included individuals with low health literacy and/or low income. Tailoring did not seem to impact on efficacy.

          Discussion

          Findings suggest that self-management interventions in populations with low income or low health literacy are most effective when three to four self-management skills are utilized, particularly when problem-solving is targeted. Healthcare providers and researchers can use these findings to develop education strategies and tools for populations with low income or low health literacy to improve chronic illness self-management.

          Electronic supplementary material

          The online version of this article (10.1007/s11606-017-4265-x) contains supplementary material, which is available to authorized users.

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          Most cited references42

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          Self-management education: History, definition, outcomes, and mechanisms

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            Evidence on the Chronic Care Model in the new millennium.

            Developed more than a decade ago, the Chronic Care Model (CCM) is a widely adopted approach to improving ambulatory care that has guided clinical quality initiatives in the United States and around the world. We examine the evidence of the CCM's effectiveness by reviewing articles published since 2000 that used one of five key CCM papers as a reference. Accumulated evidence appears to support the CCM as an integrated framework to guide practice redesign. Although work remains to be done in areas such as cost-effectiveness, these studies suggest that redesigning care using the CCM leads to improved patient care and better health outcomes.
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              Improving diabetes self-management through acceptance, mindfulness, and values: a randomized controlled trial.

              Patients in a low-income community health center with Type 2 diabetes (N = 81) taking a one-day education workshop as part of their diabetes medical management were randomly assigned either to education alone or to a combination of education and acceptance and commitment therapy (ACT). Both groups were taught how to manage their diabetes, but those in the ACT condition also learned to apply acceptance and mindfulness skills to difficult diabetes-related thoughts and feelings. Compared with patients who received education alone, after 3 months those in the ACT condition were more likely to use these coping strategies, to report better diabetes self-care, and to have glycated hemoglobin (HbA-sub(1C)) values in the target range. Mediational analyses indicated that changes in acceptance coping and self-management behavior mediated the impact of treatment on changes in HbA-sub(1C). Copyright 2007 APA, all rights reserved.
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                Author and article information

                Contributors
                jamie.schaffler@mail.mcgill.ca
                katerina.leung@mail.mcgill.ca
                sarah.tremblay2@mail.mcgill.ca
                laura.merdsoy@mail.mcgill.ca
                eric.belzile@ssss.gouv.qc.ca
                Angella.lambrou@mcgill.ca
                514-797-3762 , sylvie.lambert@mcgill.ca
                Journal
                J Gen Intern Med
                J Gen Intern Med
                Journal of General Internal Medicine
                Springer US (New York )
                0884-8734
                1525-1497
                9 February 2018
                April 2018
                : 33
                : 4
                : 510-523
                Affiliations
                [1 ] ISNI 0000 0004 1936 8649, GRID grid.14709.3b, Ingram School of Nursing, McGill University, ; Quebec, Montreal Canada
                [2 ]St. Mary’s Research Centre, Quebec, Montreal Canada
                [3 ] ISNI 0000 0004 1936 8649, GRID grid.14709.3b, Schulich Library of Science and Engineering, McGill University, ; Quebec, Montreal Canada
                Article
                PMC5880764 PMC5880764 5880764 4265
                10.1007/s11606-017-4265-x
                5880764
                29427178
                bb4f007b-4714-46b4-a228-2a247b48905a
                © Society of General Internal Medicine 2018
                History
                : 3 November 2017
                : 20 November 2017
                : 4 December 2017
                Categories
                Review Paper
                Custom metadata
                © Society of General Internal Medicine 2018

                chronic disease,disease management,vulnerable populations,self-management,health literacy

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