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Table 4 Effects on socioeconomic disparities: Studies examining outcomes from SM interventions, stratified by quality

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

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

  1. 1Population SES status terms have been structured to maximise comparability between papers.
  2. 2EM ethnic minority
  3. 3Literacy was used as an SES measure where it was clearly correlated with education and income.