The comparative efficacy of comprehensive self-care interventions in chronic illness: An updated meta-analysis of randomized controlled trials

Abstract

Background The efficacy of self-care interventions is not well understood in part because of variation in the domains of self-care being targeted as well as in modes of intervention delivery and behavioral change techniques used in trials. Objective The goal of this study was to synthesize the efficacy of comprehensive self-care interventions on relevant outcomes across six common chronic illnesses. Design Meta-analysis, meta-regression, and subgroup comparisons. Methods Data extraction focused on randomized controlled trials published between 2008 and 2022 designed to enhance comprehensive self-care interventions (i.e. those that focus on all three self-care domains of maintenance, monitoring, and management) in asthma, coronary artery disease, chronic obstructive pulmonary disease, type 2 diabetes mellitus, heart failure, and hypertension. Data were pooled using random-effects meta-analyses. Meta-regression and subgroup analyses were used to quantify the year of publication and both modes of delivery and behavioral change techniques on intervention efficacy, respectively. Results 145 interventions tested in 140 trials involving 31,642 participants were included. The efficacy of comprehensive self-care interventions on improving outcomes was moderate in effect size and heterogeneous (g = 0.40 (95%CI=0.35–0.45), p < 0.001; χ2= 898.7, p < 0.001, I 2=83.9%). In meta-regression, the efficacy of interventions improved linearly between 2008 and 2022 (slope = 0.017 (95%CI=0.001–0.032); z = 2.08, p = 0.038). Interventions using individual face-to-face or telephone modes of delivery, and those employing behavioral feedback, social support or reminders were more efficacious compared with interventions that did not use these features (all p < 0.05). Conclusions Comprehensive self-care interventions have moderate efficacy in improving outcomes, especially those using certain modes of delivery and behavioral change techniques, and should be considered for adults with chronic illness.