Topic
Self-management
About: Self-management is a research topic. Over the lifetime, 865 publications have been published within this topic receiving 18419 citations.
Papers published on a yearly basis
Papers
TL;DR: The effects of mobile phone messaging applications designed to facilitate self-management of long-term illnesses, in terms of impact on health outcomes and patients' capacity to self-manage their condition are assessed.
Abstract: Background
Long-term illnesses affect a significant proportion of the population in developed and developing countries Mobile phone messaging applications, such as Short Message Service (SMS) and Multimedia Message Service (MMS), may present convenient, cost-effective ways of supporting self-management and improving patients' self-efficacy skills through, for instance, medication reminders, therapy adjustments or supportive messages
Objectives
To assess the effects of mobile phone messaging applications designed to facilitate self-management of long-term illnesses, in terms of impact on health outcomes and patients' capacity to self-manage their condition Secondary objectives include assessment of: user evaluation of the intervention; health service utilisation and costs; and possible risks and harms associated with the intervention
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL,The Cochrane Library 2009, Issue 2), MEDLINE (OvidSP) (January 1993 to June 2009), EMBASE (OvidSP) (January 1993 to June 2009), PsycINFO (OvidSP) (January 1993 to June 2009), CINAHL (EbscoHOST) (January 1993 to June 2009), LILACS (January 1993 to June 2009) and African Health Anthology (January 1993 to June 2009)
We also reviewed grey literature (including trial registers) and reference lists of articles
Selection criteria
We included randomised controlled trials (RCTs), quasi-randomised controlled trials (QRCTs), controlled before-after (CBA) studies, or interrupted time series (ITS) studies with at least three time points before and after the intervention We selected only studies where it was possible to assess the effects of mobile phone messaging independent of other technologies or interventions
Data collection and analysis
Two review authors independently assessed all studies against the inclusion criteria, with any disagreements resolved by a third review author Study design features, characteristics of target populations, interventions and controls, and results data were extracted by two review authors and confirmed by a third Primary outcomes of interest were health outcomes as a result of the intervention and capacity to self-manage long-term conditions We also considered patients' and providers' evaluation of the intervention, perceptions of safety, health service utilisation and costs, and potential harms or adverse effects The included studies were heterogeneous in type of condition addressed, intervention characteristics and outcome measures Therefore, a meta-analysis to derive an overall effect size for the main outcome categories was not considered justified and findings are presented narratively
Main results
We included four randomised controlled trials involving 182 participants
For the primary outcome of health outcomes, including physiological measures, there is moderate quality evidence from two studies involving people with diabetes showing no statistical difference from text messaging interventions compared with usual care or email reminders for glycaemic control (HbA1c), the frequency of diabetic complications, or body weight There is moderate quality evidence from one study of hypertensive patients that the mean blood pressure and the proportion of patients who achieved blood pressure control were not significantly different in the intervention and control groups, and that there was no statistically significant difference in mean body weight between the groups There is moderate quality evidence from one study that asthma patients receiving a text messaging intervention experienced greater improvements on peak expiratory flow variability (mean difference (MD) -1112, 95% confidence interval (CI) -1956 to -268) and the pooled symptom score comprising four items (cough, night symptoms, sleep quality, and maximum tolerated activity) (MD -036, 95% CI -056 to -017) compared with the control group However, the study found no significant differences between the groups in impact on forced vital capacity or forced expiratory flow in 1 second
For the primary outcome of capacity to self-manage the condition, there is moderate quality evidence from one study that diabetes patients receiving the text messaging intervention demonstrated improved scores on measures of self-management capacity (Self-Efficacy for Diabetes score (MD 610, 95% CI 045 to 1175), Diabetes Social Support Interview pooled score (MD 439, 95% CI 285 to 592)), but did not show improved knowledge of diabetes There is moderate quality evidence from three studies of the effects on treatment compliance One study showed an increase in hypertensive patients' rates of medication compliance in the intervention group (MD 890, 95% CI 018 to 1762) compared with the control group, but in another study there was no statistically significant effect on rates of compliance with peak expiratory flow measurement in asthma patients Text message prompts for diabetic patients initially also resulted in a higher number of blood glucose results sent back (460) than email prompts did (235)
For the secondary outcome of participants' evaluation of the intervention, there is very low quality evidence from two studies that patients receiving mobile phone messaging support reported perceived improvement in diabetes self-management, wanted to continue receiving messages, and preferred mobile phone messaging to email as a method to access a computerised reminder system
For the secondary outcome of health service utilisation, there is very low quality evidence from two studies Diabetes patients receiving text messaging support made a comparable number of clinic visits and calls to an emergency hotline as patients without the support For asthma patients the total number of office visits was higher in the text messaging group, whereas the number of hospital admissions was higher for the control group
Because of the small number of trials included, and the low overall number of participants, for any of the reviewed outcomes the quality of the evidence can at best be considered moderate
Authors' conclusions
We found some, albeit very limited, indications that in certain cases mobile phone messaging interventions may provide benefit in supporting the self-management of long-term illnesses However, there are significant information gaps regarding the long-term effects, acceptability, costs, and risks of such interventions Given the enthusiasm with which so-called mHealth interventions are currently being implemented, further research into these issues is needed
681 citations
TL;DR: The evidence indicates the potential of apps in improving symptom management through self-management interventions in mHealth has the potential to improve health outcomes among those living with chronic diseases through enhanced symptom control.
Abstract: Background: Long-term conditions and their concomitant management place considerable pressure on patients, communities, and health care systems worldwide. International clinical guidelines on the majority of long-term conditions recommend the inclusion of self-management programs in routine management. Self-management programs have been associated with improved health outcomes; however, the successful and sustainable transfer of research programs into clinical practice has been inconsistent. Recent developments in mobile technology, such as mobile phone and tablet computer apps, could help in developing a platform for the delivery of self-management interventions that are adaptable, of low cost, and easily accessible. Objective: We conducted a systematic review to assess the effectiveness of mobile phone and tablet apps in self-management of key symptoms of long-term conditions. Methods: We searched PubMed, Embase, EBSCO databases, the Cochrane Library, and The Joanna Briggs Institute Library for randomized controlled trials that assessed the effectiveness of mobile phone and tablet apps in self-management of diabetes mellitus, cardiovascular disease, and chronic lung diseases from 2005–2016. We searched registers of current and ongoing trials, as well as the gray literature. We then checked the reference lists of all primary studies and review papers for additional references. The last search was run in February 2016. Results: Of the 9 papers we reviewed, 6 of the interventions demonstrated a statistically significant improvement in the primary measure of clinical outcome. Where the intervention comprised an app only, 3 studies demonstrated a statistically significant improvement. Interventions to address diabetes mellitus (5/9) were the most common, followed by chronic lung disease (3/9) and cardiovascular disease (1/9). A total of 3 studies included multiple intervention groups using permutations of an intervention involving an app. The duration of the intervention ranged from 6 weeks to 1 year, and final follow-up data ranged from 3 months to 1 year. Sample size ranged from 48 to 288 participants. Conclusions: The evidence indicates the potential of apps in improving symptom management through self-management interventions. The use of apps in mHealth has the potential to improve health outcomes among those living with chronic diseases through enhanced symptom control. Further innovation, optimization, and rigorous research around the potential of apps in mHealth technology will move the field toward the reality of improved health care delivery and outcomes. [J Med Internet Res 2016;18(5):e97]
677 citations
TL;DR: A smartphone system that targets medication adherence, mood regulation, sleep, social functioning, and coping with symptoms for people with schizophrenia is developed, and the system was adapted to address consumer needs and preferences accordingly.
Abstract: Objective: Mobile Health (mHealth) approaches can support the rehabilitation of individuals with psychiatric conditions. In the current article, we describe the development of a smartphone illness self-management system for people with schizophrenia. Methods: The research was conducted with consumers and practitioners at a community-based rehabilitation agency. Stage 1: 904 individuals with schizophrenia or schizoaffective disorder completed a survey reporting on their current use of mobile devices and interest in mHealth services. Eight practitioners completed a survey examining their attitudes and expectations from an mHealth intervention, and identified needs and potential obstacles. Stage 2: A multidisciplinary team incorporated consumer and practitioner input and employed design principles for the development of e-resources for people with schizophrenia to produce an mHealth intervention. Stage 3: 12 consumers participated in laboratory usability sessions. They performed tasks involved in operating the new system, and provided “think aloud” commentary and post-session usability ratings. Results: 570 (63%) of survey respondents reported owning a mobile device and many expressed interest in receiving mHealth services. Most practitioners believed that consumers could learn to use and would benefit from an mHealth intervention. In response, we developed a smartphone system that targets medication adherence, mood regulation, sleep, social functioning, and coping with symptoms. Usability testing revealed several design vulnerabilities, and the system was adapted to address consumer needs and preferences accordingly. Conclusions and Implications for Practice: Through a comprehensive development process, we produced an mHealth illness self-management intervention that is likely to be used successfully, and is ready for deployment and systemic evaluation in real-world conditions.
326 citations
TL;DR: The results were inconclusive and the evidence was judged to have a grade of low quality because further evidence is very likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimate.
Abstract: Background Asthma is one of the most common long-term conditions worldwide, which places considerable pressure on patients, communities
and health systems. The major international clinical guidelines now recommend the inclusion of self management programmes in
the routine management of patients with asthma. These programmes have been associated with improved outcomes in patients with
asthma. However, the implementation of self management programmes in clinical practice, and their uptake by patients, is still poor.
Recent developments in mobile technology, such as smartphone and tablet computer apps, could help develop a platform for the
delivery of self management interventions that are highly customisable, low-cost and easily accessible. Objectives To assess the effectiveness, cost-effectiveness and feasibility of using smartphone and tablet apps to facilitate the self management of
individuals with asthma. Search methods We searched the Cochrane Airways Group Register (CAGR), the Cochrane Central Register of Controlled Trials (CENTRAL),
MEDLINE, EMBASE, PsycINFO, CINAHL, GlobalHealth Library, Compendex/Inspec/Referex, IEEEXplore, ACMDigital Library,
CiteSeerx and CAB abstracts via Web of Knowledge. We also searched registers of current and ongoing trials and the grey literature.
We checked the reference lists of all primary studies and review articles for additional references. We searched for studies published
from 2000 onwards. The latest search was run in June 2013. Selection criteria We included parallel randomised controlled trials (RCTs) that compared self management interventions for patients with cliniciandiagnosed
asthma delivered via smartphone apps to self management interventions delivered via traditional methods (e.g. paper-based
asthma diaries). Data collection and analysis
We used standard methods expected by the Cochrane Collaboration. Our primary outcomes were symptom scores; frequency of
healthcare visits due to asthma exacerbations or complications and health-related quality of life. Main results We included two RCTs with a total of 408 participants. We found no cluster RCTs, controlled before and after studies or interrupted
time series studies that met the inclusion criteria for this systematic review. Both RCTs evaluated the effect of a mobile phone-based
asthma self management intervention on asthma control by comparing it to traditional, paper-based asthma self management. One
study allowed participants to keep daily entries of their asthma symptoms, asthma medication usage, peak flow readings and peak flow
variability on their mobile phone, from which their level of asthma control was calculated remotely and displayed together with the
corresponding asthma self management recommendations. In the other study, participants recorded the same readings twice daily, and
they received immediate selfmanagement feedback in the form of a three-colour traffic light display on their phones. Participants falling
into the amber zone of their action plan twice, or into the red zone once, received a phone call from an asthma nurse who enquired
about the reasons for their uncontrolled asthma.
We did not conduct a meta-analysis of the data extracted due to the considerable degree of heterogeneity between these studies. Instead
we adopted a narrative synthesis approach. Overall, the results were inconclusive and we judged the evidence to have a GRADE rating
of low quality because further evidence is very likely to have an important impact on our confidence in the estimate of effect and is
likely to change the estimate. In addition, there was not enough information in one of the included studies to assess the risk of bias for
themajority of the domains. Although the other included study was methodologically rigorous, it was not possible to blind participants
or personnel in the study. Moreover, there are concerns in both studies in relation to attrition bias and other sources of bias.
One study showed that the use of a smartphone app for the delivery of an asthma self management programme had no statistically
significant effect on asthma symptom scores (mean difference (MD) 0.01, 95% confidence interval (CI) -0.23 to 0.25), asthma-related
quality of life (MD of mean scores 0.02, 95% CI -0.35 to 0.39), unscheduled visits to the emergency department (OR 7.20, 95% CI
0.37 to 140.76) or frequency of hospital admissions (odds ratio (OR) 3.07, 95% CI 0.32 to 29.83). The other included study found
that the use of a smartphone app resulted in higher asthma-related quality of life scores at six-month follow-up (MD5.50, 95%CI 1.48
to 9.52 for the physical component score of the SF-12 questionnaire; MD 6.00, 95% CI 2.51 to 9.49 for the mental component score
of the SF-12 questionnaire), improved lung function (PEFR) at four (MD 27.80, 95% CI 4.51 to 51.09), five (MD 31.40, 95% CI
8.51 to 54.29) and six months (MD 39.20, 95% CI 16.58 to 61.82), and reduced visits to the emergency department due to asthmarelated
complications (OR 0.20, 95% CI 0.04 to 0.99). Both studies failed to find any statistical differences in terms of adherence to
the intervention and occurrence of other asthma-related complications. Authors’ conclusions The current evidence base is not sufficient to advise clinical practitioners, policy-makers and the general public with regards to the use
of smartphone and tablet computer apps for the delivery of asthma selfmanagement programmes. In order to understand the efficacy of
apps as standalone interventions, future research should attempt to minimise the differential clinical management of patients between
control and intervention groups. Those studies evaluating apps as part of complex, multicomponent interventions, should attempt
to tease out the relative contribution of each intervention component. Consideration of the theoretical constructs used to inform the
development of the intervention would help to achieve this goal. Finally, researchers should also take into account: the role of ancillary
components in moderating the observed effects, the seasonal nature of asthma and long-term adherence to self management practices.
313 citations
TL;DR: This study found that the use of a mobile phone–based self-management system used for 1 year, with or without telephone health counseling by a diabetes specialist nurse for the first 4 months, could improve glycated hemoglobin A1c (HbA1c) level, self- management, and health-related quality of life compared with usual care.
Abstract: Background: Self-management is crucial in the daily management of type 2 diabetes. It has been suggested that mHealth may be an important method for enhancing self-management when delivered in combination with health counseling. Objective: The objective of this study was to test whether the use of a mobile phone–based self-management system used for 1 year, with or without telephone health counseling by a diabetes specialist nurse for the first 4 months, could improve glycated hemoglobin A1c (HbA1c) level, self-management, and health-related quality of life compared with usual care. Methods: We conducted a 3-arm prospective randomized controlled trial involving 2 intervention groups and 1 control group. Eligible participants were persons with type 2 diabetes with an HbA 1c level ≥7.1% (≥54.1 mmol/mol) and aged ≥18 years. Both intervention groups received the mobile phone–based self-management system Few Touch Application (FTA). The FTA consisted of a blood glucose–measuring system with automatic wireless data transfer, diet manual, physical activity registration, and management of personal goals, all recorded and operated using a diabetes diary app on the mobile phone. In addition, one intervention group received health counseling based on behavior change theory and delivered by a diabetes specialist nurse for the first 4 months after randomization. All groups received usual care by their general practitioner. The primary outcome was HbA1c level. Secondary outcomes were self-management (heiQ), health-related quality of life (SF-36), depressive symptoms (CES-D), and lifestyle changes (dietary habits and physical activity). Data were analyzed using univariate methods (t test, ANOVA) and multivariate linear and logistic regression. Results: A total of 151 participants were randomized: 51 to the FTA group, 50 to the FTA-health counseling (FTA-HC) group, and 50 to the control group. Follow-up data after 1 year were available for 120 participants (79%). HbA1c level decreased in all groups, but did not differ between groups after 1 year. The mean change in the heiQ domain skills and technique acquisition was
287 citations
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Performance Metrics
| Year | Papers |
|---|---|
| 2025 | 107 |
| 2024 | 183 |
| 2023 | 255 |
| 2022 | 476 |
| 2021 | 104 |
| 2020 | 88 |