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Hearn J, Ssinabulya I, Schwartz JI, Akiteng AR, Ross HJ, Cafazzo JA. Self-management of non-communicable diseases in low- and middle-income countries: A scoping review. PLoS One 2019; 14:e0219141. [PMID: 31269070 PMCID: PMC6608949 DOI: 10.1371/journal.pone.0219141] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 06/17/2019] [Indexed: 12/30/2022] Open
Abstract
Background The prevalence of non-communicable diseases (NCDs) is rising in low- and middle-income countries (LMICs). Self-management, which enables patients to better manage their health, presents a potentially-scalable means of mitigating the growing burden of NCDs in LMICs. Though the effectiveness of self-management interventions in high-income countries is well-documented, the use of these strategies in LMICs has yet to be thoroughly summarized. Objective The purpose of this scoping review is to summarize the nature and effectiveness of past interventions that have enabled the self-management of NCDs in LMICs. Methods Using the scoping review methodology proposed by Arksey and O’Malley, PubMed was searched for relevant articles published between January 2007 and December 2018. The implemented search strategy comprised three major themes: self-management, NCDs and LMICs. Results Thirty-six original research articles were selected for inclusion. The selected studies largely focused on the self-management of diabetes (N = 21), hypertension (N = 7) and heart failure (N = 5). Most interventions involved the use of short message service (SMS, N = 17) or phone calls (N = 12), while others incorporated educational sessions (N = 10) or the deployment of medical devices (N = 4). The interventions were generally effective and often led to improvements in physiologic indicators, patient self-care and/or patient quality of life. However, the studies emphasized results in small populations, with little indication of future scaling of the intervention. Furthermore, the results indicate a need for further research into the self-management of cardiovascular diseases, as well as for the co-management of diabetes and cardiovascular disease. Conclusions Self-management appears to be an effective means of improving health outcomes in LMICs. Future strategies should include patients and clinicians in all stages of design and development, allowing for a focus on long-term sustainability, scalability and interoperability of the intervention in the target setting.
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Affiliation(s)
- Jason Hearn
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Isaac Ssinabulya
- Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Jeremy I. Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Heather J. Ross
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joseph A. Cafazzo
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- * E-mail:
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Persaud N, Steiner L, Woods H, Aratangy T, Wanigaratne S, Polsky J, Hwang S, Chahal G, Pinto A. Health outcomes related to the provision of free, tangible goods: A systematic review. PLoS One 2019; 14:e0213845. [PMID: 30893372 PMCID: PMC6426236 DOI: 10.1371/journal.pone.0213845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/03/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Free provision of tangible goods that may improve health is one approach to addressing discrepancies in health outcomes related to income, yet it is unclear whether providing goods for free improves health. We systematically reviewed the literature that reported the association between the free provision of tangible goods and health outcomes. METHODS A search was performed for relevant literature in all languages from 1995-May 2017. Eligible studies were observational and experimental which had at least one tangible item provided for free and had at least one quantitative measure of health. Studies were excluded if the intervention was primarily a service and the free good was relatively unimportant; if the good was a medication; or if the data in a study was duplicated in another study. Covidence screening software was used to manage articles for two levels of screening. Data was extracted using an adaption of the Cochrane data collection template. Health outcomes, those that affect the quality or duration of life, are the outcomes of interest. The study was registered with PROSPERO (CRD42017069463). FINDINGS The initial search identified 3370 articles and 59 were included in the final set with a range of 20 to 252 246 participants. The risk of bias assessment revealed that overall, the studies were of medium to high quality. Among the studies included in this review, 80 health outcomes were statistically significant favouring the intervention, 19 health outcomes were statistically significant favouring the control, 141 health outcomes were not significant and significance was unknown for 28 health outcomes. INTERPRETATION The results of this systematic review provide evidence that free goods can improve health outcomes in certain circumstances, although there were important gaps and limitations in the existing literature.
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Affiliation(s)
- Nav Persaud
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Liane Steiner
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Hannah Woods
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Tatiana Aratangy
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | | | - Jane Polsky
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Stephen Hwang
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
- Division of General Internal Medicine, University of Toronto, Toronto, Canada
| | - Gurleen Chahal
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Andrew Pinto
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- The Upstream Lab, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Terens N, Vecchi S, Bargagli AM, Agabiti N, Mitrova Z, Amato L, Davoli M. Quality improvement strategies at primary care level to reduce inequalities in diabetes care: an equity-oriented systematic review. BMC Endocr Disord 2018; 18:31. [PMID: 29843692 PMCID: PMC5975519 DOI: 10.1186/s12902-018-0260-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/16/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There is evidence that disparities exist in diabetes prevalence, access to diabetes care, diabetes-related complications, and the quality of diabetes care. A wide range of interventions has been implemented and evaluated to improve diabetes care. We aimed to review trials of quality improvement (QI) interventions aimed to reduce health inequities among people with diabetes in primary care and to explore the extent to which experimental studies addressed and reported equity issues. METHODS Pubmed, EMBASE, CINAHL, and the Cochrane Library were searched to identify randomized controlled studies published between January 2005 and May 2016. We adopted the PROGRESS Plus framework, as a tool to explore differential effects of QI interventions across sociodemographic and economic factors. RESULTS From 1903 references fifty-eight randomized trials met the inclusion criteria (with 17.786 participants), mostly carried out in USA. The methodological quality was good for all studies. Almost all studies reported the age, gender/sex and race distribution of study participants. The majority of trials additionally used at least one further PROGRESS-Plus factor at baseline, with education being the most commonly used, followed by income (55%). Large variation was observed between these studies for type of interventions, target populations, and outcomes evaluated. Few studies examined differential intervention effects by PROGRESS-plus factors. Existing evidence suggests that some QI intervention delivered in primary care can improve diabetes-related health outcomes in social disadvantaged population subgroups such as ethnic minorities. However, we found very few studies comparing health outcomes between population subgroups and reporting differential effect estimates of QI interventions. CONCLUSIONS This review provides evidence that QI interventions for people with diabetes is feasible to implement and highly acceptable. However, more research is needed to understand their effective components as well as the adoption of an equity-oriented approach in conducting primary studies. Moreover, a wider variety of socio-economic characteristics such as social capital, place of residence, occupation, education, and religion should be addressed.
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Affiliation(s)
| | - Simona Vecchi
- Department of Epidemiology, Lazio Region- ASL Rome1, Rome, Italy
| | | | - Nera Agabiti
- Department of Epidemiology, Lazio Region- ASL Rome1, Rome, Italy
| | - Zuzana Mitrova
- Department of Epidemiology, Lazio Region- ASL Rome1, Rome, Italy
| | - Laura Amato
- Department of Epidemiology, Lazio Region- ASL Rome1, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Region- ASL Rome1, Rome, Italy
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Ahmadi Z, Sadeghi T, Loripoor M. The outcomes of peer-led diabetes education in comparison to education delivered by health professionals in Iranian patients. HEALTH EDUCATION RESEARCH 2018; 33:64-72. [PMID: 29088414 DOI: 10.1093/her/cyx068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 10/14/2017] [Indexed: 06/07/2023]
Abstract
Education is an important aspect of care for diabetic patients. This study aimed to compare the effect of education by health care provider and peer on self-care behaviors among Iranian patients with diabetes. In this clinical randomized control trial, we enrolled 120 patients with type 2 diabetes who were referred to the Diabetes Clinic at a university medical center hospital in an urban area of Iran. Participants were randomly allocated into three groups. Patients in care provider group (CPG) received additional education provided by a nurse, other than routine education in a Diabetes Clinic. Patients in peer education group (PEG) received education given by a peer. Patients in control group (CG) received the routine education in accordance with the usual procedures at the Diabetes Clinic. Data collected at baseline and 12 weeks (3 months) were demographic variables and diabetes self-care activities. Self-care behaviors post intervention differed significantly by group; PEG patients demonstrated the greatest improvement. CG patients' self-care behaviors did not change significantly and were significantly lower than scores by CPG and PEG patients. In line with the World Health Organization recommendations, future studies are warranted to confirm the effectiveness of peer-led education among diabetic patients in the Iranian culture.
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Affiliation(s)
- Zakieh Ahmadi
- Department of Nursing, School of Nursing and Midwifery, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Tabandeh Sadeghi
- Department of Pediatric Nursing, School of Nursing and Midwifery; Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Marzeyeh Loripoor
- Department of Midwifery, School of Nursing and Midwifery; Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Shi M, Xu MY, Liu ZL, Duan XY, Zhu YB, Shi HM, Jiang B, Zhang XM, Yu XH. Effectiveness of family involvement in newly diagnosed type 2 diabetes patients: a follow-up study. PATIENT EDUCATION AND COUNSELING 2016; 99:776-782. [PMID: 26763869 DOI: 10.1016/j.pec.2015.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 12/22/2015] [Accepted: 12/26/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the effects of family-involvement on health education for T2DM from the aspects of knowledge, attitude and practice (KAP), health-related quality of life (HRQoL), body mass index (BMI) and glucose control. METHODS A follow-up study was performed and patients with newly diagnosed T2DM were divided into family-involved group (FIG, n=60) and single-involved group (SIG, n=60). Hierarchical linear models were used to assess within-group changes and between-group differences in the glycosylated hemoglobin A1c (HbA1c), KAP, SF-36 and BMI. RESULTS Significant improvements in FIG along with significant differences between-group were seen for HbA1c levels (9.73, 8.92, 5.55, 5.79, 5.30 vs. 10.05, 9.53, 6.36, 8.41, 6.58) in baseline, M3, M6, M12, M24 compared with SIG, respectively (all P≤0.001). Significant improvements in FIG along with significant differences between-group were seen for KAP (16.23, 46.98, 48.93 vs. 16.65, 29.07, 37.62), SF-36 (78.04, 92.68, 92.34 vs. 74.96, 77.03, 78.25), and BMI (24.74, 23.46, 22.96 vs. 24.00, 23.45, 23.50) in baseline, M12 and M24, respectively (all P≤0.05). CONCLUSION Family involvement is beneficial to the control of T2DM and should be suggested for T2DM newly diagnosed. PRACTICE IMPLICATIONS Health education should encourage the family to participate in the whole process to improve the efficacy of education.
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Affiliation(s)
- Mai Shi
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China; Department of Clinical Nutrition, China-Japan Friendship Hospital, Beijing 100029, China
| | - Mei-Yan Xu
- Department of Clinical Nutrition, The Central Hospital of China Aerospace Corporation, Beijing 100049, China
| | - Zhao-Lan Liu
- Centre for Evidence-based Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xue-Ying Duan
- Department of Clinical Nutrition, Yan-Hua Hospital, Beijing 100250, China
| | - Yan-Bo Zhu
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China.
| | - Hui-Mei Shi
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Bo Jiang
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xiao-Mei Zhang
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xiao-Han Yu
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China
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Shi M, Liu ZL, Zhu YB, Xu MY, Duan XY, Shi HM, Jiang B, Zhang XM, Yu XH. Effect of Health Education Based on Integrative Therapy of Chinese and Western Medicine for Adult Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Study. Chin J Integr Med 2015; 24:94-102. [DOI: 10.1007/s11655-015-2113-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Indexed: 10/22/2022]
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Liu Y, Han Y, Shi J, Li R, Li S, Jin N, Gu Y, Guo H. Effect of peer education on self-management and psychological status in type 2 diabetes patients with emotional disorders. J Diabetes Investig 2014. [PMID: 26221528 PMCID: PMC4511309 DOI: 10.1111/jdi.12311] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Aims/Introduction The purpose of the present study was to assess the effect of peer education in type 2 diabetes patients with emotional disorders on the metabolic index and psychological status. Materials and Methods Educators use psychological scales to screen type 2 diabetes patients with emotional disorders. Participants were divided into usual and peer education groups. Both groups received usual diabetes education. Peer leaders were recruited to provide support with the peer education group for 6 months. The metabolic index, diabetes knowledge, self-management, diabetes-related distress, emotional status and quality of life were compared at the end of the study. Results A total of 127 patients participated in the study. There were 20 peer leaders engaged in the study as volunteers for peer education. All participants completed the study and fulfilled the scales. Improvements in the peer education group were significant compared with the usual education group with respect to anxiety (49.0 ± 9.65 vs 54.0 ± 8.48), depression (51.3 ± 7.97 vs 55.8 ± 7.52), diabetes knowledge (18.8 ± 2.46 vs 16.3 ± 2.08), distress (2.67 ± 0.55 vs 3.02 ± 0.56), self-management (66.5 ± 4.26 vs 62.4 ± 5.88) and quality of life (−1.98 ± 0.82 vs −2.50 ± 0.71), whereas no significant difference existed with respect to the metabolic index. Conclusions Peer education, providing more attention to diabetes patients with emotional disorders, is a preferred model for delivering care.
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Affiliation(s)
- Yan Liu
- General Hospital of Dagang Oilfield, Tianjin Medical University Tianjin, China
| | - Ying Han
- General Hospital of Dagang Oilfield, Tianjin Medical University Tianjin, China
| | - Jieli Shi
- General Hospital of Dagang Oilfield, Tianjin Medical University Tianjin, China
| | - Ruixia Li
- General Hospital of Dagang Oilfield, Tianjin Medical University Tianjin, China
| | - Sufen Li
- General Hospital of Dagang Oilfield, Tianjin Medical University Tianjin, China
| | - Nana Jin
- General Hospital of Dagang Oilfield, Tianjin Medical University Tianjin, China
| | - Yong Gu
- The Fifth People's Hospital Of Shanghai, Fudan University Shanghai, China
| | - Honglei Guo
- The Fifth People's Hospital Of Shanghai, Fudan University Shanghai, China ; Key Laboratory of Hormones, Tianjin Medical University Tianjin, China
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Guo H, Tian X, Li R, Lin J, Jin N, Wu Z, Yu D. Reward-based, task-setting education strategy on glycemic control and self-management for low-income outpatients with type 2 diabetes. J Diabetes Investig 2013; 5:410-7. [PMID: 25411600 PMCID: PMC4210071 DOI: 10.1111/jdi.12152] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 07/28/2013] [Accepted: 08/25/2013] [Indexed: 01/24/2023] Open
Abstract
AIMS/INTRODUCTION The purpose of the study was to determine the feasibility and effect of a reward-based, task-setting strategy for low-income outpatients with type 2 diabetes. MATERIALS AND METHODS Indigent diabetes outpatients without glucometers were eligible to participate in this trial. A total of 132 cases were randomly recruited. Participants in group B used glucometers for self-monitoring at no cost. Group A participants could keep the glucometers only if the glycosylated hemoglobin level declined compared with the baseline visit; for those not achieving a reduction in the glycosylated hemoglobin level, the glucometers would have to be returned. Group C served as the control group without self-monitoring setout. Diabetes education was provided to all groups. Metabolic indices and self-management were evaluated after 6 months of follow up. RESULTS Group A had a significant decline in the glycosylated hemoglobin level (-0.97%) and medical costs (-159 yuan) compared with the baseline visit, whereas groups B and C had a decrease in the glycosylated hemoglobin levels alone (-0.62 and -0.57%, respectively). The body mass index did not change significantly in any group. There was a statistical difference in the glycosylated hemoglobin level of group A compared with groups B and C. Self-management in group A improved the outcome relative to groups B and C. CONCLUSIONS This preliminary evidence suggests that the program is feasible, acceptable for improving patient self-management, and cost-effective in reducing the glycosylated hemoglobin level and medical costs.
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Affiliation(s)
- Honglei Guo
- Key Laboratory of Hormones and Development (Ministry of Health) Metabolic Diseases Hospital & Tianjin Institute of Endocrinology Tianjin Medical University Tianjin China
| | - Xiaoli Tian
- Key Laboratory of Hormones and Development (Ministry of Health) Metabolic Diseases Hospital & Tianjin Institute of Endocrinology Tianjin Medical University Tianjin China
| | - Rixia Li
- General Hospital of Dagang Oilfield Tianjin China
| | - Jingna Lin
- Tianjin Municipal People's Hospital Tianjin China
| | - Nana Jin
- General Hospital of Dagang Oilfield Tianjin China
| | - Zhongming Wu
- Key Laboratory of Hormones and Development (Ministry of Health) Metabolic Diseases Hospital & Tianjin Institute of Endocrinology Tianjin Medical University Tianjin China
| | - Demin Yu
- Key Laboratory of Hormones and Development (Ministry of Health) Metabolic Diseases Hospital & Tianjin Institute of Endocrinology Tianjin Medical University Tianjin China
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