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Table 2 Studies examining disparities in outcomes following SM interventions, stratified by quality1

From: What impact do chronic disease self-management support interventions have on health inequity gaps related to socioeconomic status: a systematic review

Author1

Country and setting

Study design

Chronic Disease

Sample size

Intervention description, healthcare providers (HCPs), SM Components2

Control

Outcomes measured

Follow up

Results

Quality rating

Rothman 2004 (Rothman 2005)

USA Public primary care clinics

RCT with subgroup analysis

Diabetes

217

Individual Phone and face-to-face SMS over 12/12 Pharmacist and nurse 1,2,3,5,6,7

Single session with pharmacist

Hb A1c and blood pressure

12/12

HbA1c improved significantly from baseline for both I/C. For higher literacy participants group there was no difference between I/C but those with low literacy had a HbA1c change of −1.4% (adjusted), CI −2.3 to − 0.6%, p < 0.001, favouring intervention. BP improved in intervention group regardless of literacy, p = 0.006

JBI 11/12

S/O 11/11

DeWalt 2012 (DeWalt 2006)

USA Hospital clinics

RCT with subgroup analysis

Chronic heart failure (HF)

605

Individual Education session then phone support for 12/12 Health educators 1,2,3,5,7,8

Single 1–1 education session

All-cause hospitalisation, death, HF hospital admission, HFQOL

12/12

In low-literacy participants adjusted incident rate ratio (IRR) was 0.73 for all-cause hospitalisation and death and 0.48 for HF hospitalisation, favouring intervention; IRR for high literacy was 1.16 for all-cause and 1.34 for HF hospitalisation, favouring control.

JBI 10/12

S/O 11/11

Bosma 2011 (Lamers 2010)

Netherlands Public primary care clinics

RCT with subgroup analysis

Diabetes or COPD with mild to moderate depression.

361

Individual Home-based CBT and SMS for 6/52 Nurses 1,3,4,6,7,8

Usual GP care

Depression primary outcome (Beck Depression Inventory); also health-related quality of life (QOL); control beliefs (mastery); self-efficacy.

9/12

Interaction between education level was significant (p < 0.05) or nearing significance (p < 0.10) at 3 and 9 months for all outcomes with no benefit for low educated. Clinically significant (> 50% improvement) in depression at 9 months for high educated only.

JBI 11/12

S/O 9/11

Moskowitz 2013 (Thom 2013)

USA Public primary care clinics

RCT with subgroup analysis

Diabetes

299

Individual Phone and face-to-face peer support over 6/12 Peer health coaches 1,3,4,5,6,8

Usual GP care

HbA1c

6/12

HbA1C reduced by 1.07% (intervention) vs 0.3% (control), p = 0.01. HbA1c decrease was predicted by SM ability and medication adherence. Those with low SM ability benefited most; ethnicity and education did not differentially affect the outcome.

JBI 10/12

S/O 9/11

Powell 2010

USA Hospital clinics

RCT with subgroup analysis

Heart failure

902

Group SMS classes over 12/12 Health professionals 1,2,3,4,5,6

Education sheets plus phone follow-up

Death/HF hospitalisation, medication adherence, salt intake, SM ability, cardiac QOL, SF 36, depression.

2.5 years

Depression, self-efficacy and salt intake improved in both intervention and control groups. Low income participants in the control group had a non-significant (p = 0.056) trend to earlier cardiac event (death/hospitalisation).

JBI 11/12

S/O 6/11

Smeulders 2010 (Smeulders 2006)

Netherlands Hospital clinics

RCT with subgroup analysis

Chronic heart failure

317

Group Stanford CDSMP for 6/52 Nurse and peer leader 1,2,3,4,5,6,7,8

Usual care

Cardiac QOL (Kansas City Cardiomyopathy Questionnaire)

12/12

Short-term improvement in cardiac QOL in intervention group but not at 6 or 12/12. Lower educated patients improved more than higher educated (p = 0.018) throughout the follow-up period.

JBI 10/12

S/O 7/10

Jonker 2012

Netherlands Elderly daycare facility

RCT with subgroup analysis

Frail elderly; unspecified chronic disease (mean of 2 CDs)

63 (intervention group)

Group Stanford CDSMP for 6/52 Nurses 1,2,3,4,5,6,7,8

Waitlist

Depression, valuation of life, control beliefs (mastery); self-efficacy, cognitive function.

6/12

Mastery (p = 0.01) and Depression (p = 0.05) scores improved from baseline in the intervention group at 6/12 (small effect size); subgroup analysis showed improvements in mastery (p < 0.05) were limited to the lower educated and those with better cognitive function.

JBI 6/12

S/O 5/11

Nour 2006

Canada Public community health centres

RCT with subgroup analysis

Arthritis and housebound

58 (intervention group)

Individual Home-based CBT and SMS for 8/52 Allied HCPs 1,3,4,5,6,8

Waitlist

Health behaviour changes, arthritis score, pain/fatigue scores, mastery, depression, self-efficacy.

8/52

Increased frequency of exercise (p < 0.001) and relaxation (p = 0.05) in intervention group but not for those with depression or perceived low SES.

JBI 5/12

S/O 5/11

Govil 2009

USA Insurance funded clinics

Cohort study

Cardiovascular disease

785

Individual and group 3/12 lifestyle programme Range of HCPs 1,3,4,5,6,7,8

None

Blood pressure, lipids, exercise tolerance, BMI, depression, adherence.

3/12

Outcomes improved significantly p < 0.05 across all education and income levels. Adherence and attendance similar across all groups. Baseline measures were significantly lower in low educated.

JBI 9/11

  1. 1Studies listed in order of quality as measured by Johanna Briggs Institute (JBI) criteria [30] and Sun/Oxman (S/O) subgroup analysis (for RCTs) criteria [27, 28]. RCTs listed first, followed by cohort studies.
  2. 2Includes additional studies from the same research group where supplementary information was obtained.
  3. 3Numbers correspond to the key components of self-management interventions as listed by Barlow et al. (Barlow): 1. Information 2. Drug management 3. Symptom management 4. Psychological management 5. Lifestyle management 6. Social support 7. Communication 8. Other (action planning, goal setting, decision making, problem solving, spirituality).