Intervention strategies that support self-care activities: an integrative study across disease/impairment groupings.
BACKGROUND
The incidence of chronic disease and people with complex chronic medical needs is increasing worldwide. Self-care is an important element for these individuals and can pose challenges both to the recipients and providers of care. Health care professionals seeking evidence on how best to support self-care face challenges finding this research. As a care concept it is typically dealt with clinically and studied relative to specific conditions. The Cochrane Database of Systematic Reviews reports on research across 52 different disease/impairment groupings, with many systematic reviews presenting inconclusive results. Although individual reviews may not offer as much evidence as hoped, it is possible that by synthesizing evidence from multiple reviews that further knowledge and direction about the supportive care professionals can provide for self-care can be found and made available to inform practice.


OBJECTIVE
To explore and evaluate the evidence on self-care interventions through a cross-cutting, integrative study.


METHODS
Types of studies: All systematic reviews contained within the Cochrane Database of Systematic Reviews.


METHODS
Participants who were either recently diagnosed with, or currently living with, a disease, disability or impairment. No age stipulation was applied.Types of interventions: Interventions focused on initiating, supporting or enhancing self-care activities.Types of outcomes: The successful engagement of the individual in self-care activities; the sustainment of self-care activities; health outcomes or health care services utilization.


METHODS
The search strategy was designed to find all systematic reviews contained within the Cochrane Database of Systematic Reviews that addressed interventions to initiate or enhance self-care. The Cochrane Library was searched directly though Wiley and through the OVID interface. Keywords and index terms were harvested from key reviews and a second round of searching was performed.


METHODS
Inclusion criteria: Inclusion criteria were guided by Orem's Theory of Self-Care. Reviews were included that addressed health deviation self-care requisites which refer to changes in self-care activities to regulate the effects of deviation from normal structure or function.


METHODS
Interventions were examined within the context of knowledge translation, using the Knowledge-to-Action framework by Graham and colleagues. Interventions were grouped into one of two sections in the framework: a) the adaptation to a specific population, or b) the sustainment of knowledge use.


RESULTS
Outcomes were classified according to the Knowledge Use and Impact framework by Graham and colleagues. This framework categorizes outcomes in terms of what is being measured (knowledge; use of knowledge) as well as the impact of the use of that knowledge (patient/ individual; provider or system outcomes).Assessment of methodological quality: Methodological quality was assessed using the JBI Critical Appraisal Checklist for Systematic Reviews. A cut-off point of 7/10 was established.


METHODS
Data were extracted from the systematic reviews using an adaptation of the standardized data extraction form, the JBI Data Extraction Form for Systematic Review of experimental/ Observational Studies.


RESULTS
Study results were synthesized and discussed in narrative form.


RESULTS
Thirty reviews were included in the analysis spanning 16 different disease/impairment groupings and representing a total of 91,170 participants. The most commonly reported intervention strategies were educational sessions (26 reviews) and self-care management plans (11 reviews), and 27 reviews assessed multiple intervention strategies. Twenty-one reviews reported statistically significant results.


CONCLUSIONS
There is an emerging body of evidence for effective self-care. This study identified two strategies (educational sessions and self-care management plans) that could be used generically as supportive care by professionals as they assist individuals with self-care.


CONCLUSIONS
The use of multiple strategies, including educational sessions and self-care management plans have been identified as options that may be effective to support adoption and sustainment of self-care activities.


CONCLUSIONS
This study highlighted the pervasive problem of heterogeneous data at the primary research level preventing the effective synthesis of current evidence. Further research to standardize the type of outcome measured and the method of measurement would advance our ability to determine 'best practices' with self-care. Cochrane systematic review authors reported their systematic review methodologies in varying degrees of detail. Also of note was the range of different methods to assess risk of bias.
1. Queen's Joanna Briggs Collaboration, Queen's University, Kingston, Ontario, Canada, K7L 3N6 2. School of Nursing, Queen's University, Kingston, Ontario, Canada, K7L 3N6 3. School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada, K7L 3N6 4. Canadian Institutes of Health Research, Ottawa, Ontario, Canada, K1A 0W9 5. National Research Council Information Centre, Institute for Information Technology, Fredericton, New Brunswick, Canada, E3B 9W4.
Christina M
CM
Godfrey
Margaret B
MB
Harrison
Rosemary
R
Lysaght
Marianne
M
Lamb
Ian D
ID
Graham
Patricia
P
Oakley