title: Understanding how self-management interventions work for disadvantaged populations living with chronic conditions: protocol for a realist synthesis.
abstract: BACKGROUND
  Self-management programmes are complex interventions aimed at improving the way individuals self-manage chronic conditions, but there are questions about the overall impact of these programmes on disadvantaged populations, in terms of their capacity to engage with and receive the benefits from these initiatives. Given the increased resources being directed towards self-management initiatives, clinicians and policy makers need knowledge on how self-management interventions work for these populations. Most systematic reviews of self-management interventions do not consider the complex interactions between implementation contexts, intervention strategies, and mechanisms that influence how self-management interventions work in real life for disadvantaged groups.
  
  
  METHODS
  To address the need for better understanding of these mechanisms and to create context-relevant knowledge, we are conducting a realist synthesis of evidence on self-management interventions for disadvantaged populations living with chronic conditions. The primary research question is: What are the key mechanisms operating in chronic condition self-management interventions among disadvantaged populations? In this protocol, we outline the steps we will take to identify the programme theory for self-management interventions and candidate middle-range theories; to search for evidence in academic and grey literature; to appraise and extract the collected evidence; to synthesise and interpret the findings to generate key context-mechanism-outcome configurations and to disseminate results to relevant stakeholder and to peer-review publications.
  
  
  RESULTS
  Understandings of how chronic conditions self-management interventions work among disadvantaged populations is essential knowledge for clinicians and other decision makers who need to know which programmes they should implement for which groups. Results will also benefit medical researchers who want to direct effort towards current gaps in knowledge in order to advance the self-management field. In addition, the study will make a contribution to the evolving body of knowledge on the realist synthesis method and, in particular, to its application to behaviour change interventions for disadvantaged populations.
authors.affiliation: School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Mills
authors.affiliation: School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Javiera
authors.initials: J
authors.lastname: Pumarino
authors.affiliation: School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Clark
authors.affiliation: Department of Sociology, University of Victoria, Victoria, British Columbia, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Carroll
authors.affiliation: Faculty of Health Sciences, Clinical and Rehabilitation Sciences, University of Sydney, Sydney, New South Wales, Australia Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dennis
authors.affiliation: Department of Gerontology, Simon Fraser University, Burnaby, British Columbia, Canada Providence Health Care, Vancouver, British Columbia, Canada.
authors.forename: Sharon
authors.initials: S
authors.lastname: Koehn
authors.affiliation: Woodward Library, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Tricia
authors.initials: T
authors.lastname: Yu
authors.affiliation: School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada Centre for Collaboration, Motivation and Innovation, Hope, British Columbia, Canada.
authors.forename: Connie
authors.initials: C
authors.lastname: Davis
authors.affiliation: Vancouver Community, Home Health Program, Vancouver Coastal Health, Vancouver, British Columbia, Canada.
authors.forename: Maylene
authors.initials: M
authors.lastname: Fong
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D006801:Humans; D012107:Research Design; D012648:Self Care; D035862:Vulnerable Populations
keywords: Chronic Diseases; Disadvantaged Populations; Interventions; Realist Synthesis; Self-Management