Study | Theory behind intervention | Individual or group? | Intensity and duration | SES adaptions made (if any) | Demographics and SES status of population1 | SES subgroup Comparison | Results (in terms of SES only) | Dropout by group and SES | Impact on disparity |
---|---|---|---|---|---|---|---|---|---|
Rothman 2004 | CDSM in low SES groups is best managed by a multidisciplinary approach that is tailored to the patient’s needs and barriers. | Individual | 2–4 phone or direct contacts a month (mean 38 min/month) over 12/12 | Literacy adaptions, practical help to address barriers | Age: 56y mean Sex: 42%M Race: 67%EM Edu: 62% < 12 yrs. Income:74% < $20,000 Literacy: 38% ≤ 6th grade3 | Literacy – above/below 6th grade. Correlated to education, income and insurance status. | Significant HbA1c improvement with intervention for low literacy group only; high literacy group did not differ between I/C. | Dropout low both before (study refusals) and during intervention; no difference for I/C or SES. | Reduced |
De Walt 2012 | People with low literacy have knowledge deficits. SMS should be adapted for their needs and provide ongoing support until mastery is achieved. | Individual | Education session + ongoing phone support for 12/12 (mean 14 calls) | Literacy adapted, intervention length varied depending on need. | Age: 60y mean Sex: 52% M Race: 61% EM2 Edu: 26% < 12 yr Income: 68% < $25,000 Literacy: 41%3 low | Literacy (S-TOFHLA). Education and subjective SES also assessed in subgroups but were weaker predictors than literacy. | Phone support more effective in low literacy group, control intervention (education session) favoured high literacy. Literacy was a stronger predictor than education/income. | Dropout equal for I/C groups and did not differ by literacy. | Reduced |
Bosma 2010 | SMS is focussed on increasing control and returning responsibility to the patient | Individual | 2-10x1hr face-to-face sessions (mean 4) for 6/52 | Extra sessions if needed | Age: 70y mean Sex: 49% M Edu: 33% primary only | Education level (primary; some high school; completed high school). | No benefit for low educated. Gains only in higher educated groups. | Increased dropout from intervention in low educated. | Increased |
Moskowitz 2013 | Low SES patients have more challenges with SM and need assistance with literacy, depression and social support. | Individual | 0–29 phone or direct contacts (median 5) over 6/12 | Patients choose own coach, language and ethnicity catered for | Age: 56y mean Sex: 49%M Race: 55% EM Edu: 36% < 12 yr | Education (less than high school; high school; some college; college degree). | Benefit for those with low medication adherence and SM ability. Education level did not affect outcome. | Dropout low both before (study refusals) and during intervention; no difference for I/C or SES. | No change |
Powell 2010 | SMS groups aim to motivate people to participate in their care by teaching SM skills. | Group | 18x2hr over 12/12 | No | Age: 63y mean Sex: 53%M Race: 40% EM Edu: 44% ≤ 12 yr Income: 52% < $30,000 | Education (high school or less; above high school) and income (above/below $30000) | No improvement overall but low- income patients in intervention group had non-significant improvement on one outcome. | Dropout high both before and during intervention (in intervention group only); not reported by SES. | No change (n.s.reduction) |
Smeulders 2010 | The CDSMP aims to increase patient responsibility for SM by increasing self-efficacy. | Group | 6 × 2.5 h over 6/52 | No | Age: 67y mean Sex:72% M Edu:64% < 12 yr | Education (under or over 12 yr education). | Low educated improved more than high educated in cardiac QOL outcomes. | Dropout high before intervention (study refusals) but no difference during intervention between I/C. | Reduced |
Jonker 2012 | SMS works by increasing self-efficacy and improving one’s control over life and health. | Group | 6 × 2.5 h over 6/52 | No | Age: 82y mean Sex: 10%M Edu: 50% ≤ 9 yr | Education (over/under 9 years) | Lower educated improved on mastery (p < 0.05) but no other benefits from multiple outcomes. | Low dropout rate (but programme part of day-care centre activities). | Reduced (one outcome) |
Nour 2006 | Arthritis SM is achieved by Increasing knowledge and adopting health behaviours. | Individual | 6-7x1hr over 8/52 | No | Age: 77y mean Sex: 10%M Edu: 47% < 9 yr Perceived SES: 12% ‘financially insecure’ | Education (over/under 9 years) and perceived SES | Overall minor gains, but not for those with depression or perceived low SES. | Low dropout rate | Increased |
Govil 2009 | SMS aims to make lifestyle changes and improve health habits. | Both | 104 h over 3/12 (4 h, 2x/week) | No | Age: 60y mean Sex: 67%M Race: 5% EM Edu: 4% < 12 yr Income: 22% < $25,000 | Education (high school or less; some college; college degree; postgrad degree). | All benefited equally – no difference across education levels, although lower educated had lower baseline measures. | High attendance, low dropout, unrelated to SES | No change |