Effectiveness of health literacy- and patient activation-targeted interventions on chronic disease self-management outcomes in outpatient settings: a systematic review
H. Hosseinzadeh
A , S. Downie B and M. Shnaigat A C
+ Author Affiliations
- Author Affiliations
A School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia.
B School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia.
C Corresponding author. Email: maks873@uowmail.edu.au
Australian Journal of Primary Health 28(2) 83-96 https://doi.org/10.1071/PY21176
Submitted: 30 July 2021 Accepted: 22 November 2021 Published: 8 February 2022
Journal Compilation © CSIRO 2022 Open Access CC BY-NC-ND
Abstract
Chronic diseases are the leading causes of morbidity and mortality and account for approximately 60% of all deaths worldwide. Self-management is a key strategy to manage chronic diseases, and there is emerging evidence recommending targeting both health literacy (HL) and patient activation (PA) to improve chronic disease self-management outcomes. The aim of this systematic review is to summarise the current evidence on the impact of HL- and PA-led interventions on self-management outcomes using randomised control trials (RCTs). Six well known databases (MEDLINE, Web of Science, Scopus, Science Citation Index, EMBASE and Academic Search Complete) were searched for RCTs of chronic disease self-management interventions targeting both HL and PA and published between 2004 and June 2021. The search terms included chronic disease, self-management, patient activation/engagement and health literacy/education. Ten studies were eligible for inclusion. We found that patients with low HL and PA levels are most likely to benefit from the interventions. The moderate improvements in PA and HL in the reviewed studies were translated into some improvements in physical activity and mental health outcomes but failed to improve patients’ quality of life and healthcare utilisation outcomes. Patients with low HL were more likely to have higher PA levels after the interventions. This review suggests that both HL and PA are essential pillars for improving chronic disease self-management outcomes. However, more studies are needed to explore the long-term impacts of a combination of HL and PA on chronic disease self-management outcomes.
Keywords: patient activation, health literacy, chronic diseases, self-management, outpatient settings, health related-outcomes, patient related outcomes, behavioural outcomes.
References
Adams RJ (2010) Improving health outcomes with better patient understanding and education. Risk Management and Healthcare Policy 3, 61–72.| Improving health outcomes with better patient understanding and education.Crossref | GoogleScholarGoogle Scholar | 22312219PubMed |
Almutairi N, Hosseinzadeh H, Gopaldasani V (2020) The effectiveness of patient activation intervention on type 2 diabetes mellitus glycemic control and self-management behaviors: a systematic review of RCTs. Primary Care Diabetes 14, 12–20.
| The effectiveness of patient activation intervention on type 2 diabetes mellitus glycemic control and self-management behaviors: a systematic review of RCTs.Crossref | GoogleScholarGoogle Scholar | 31543458PubMed |
Ansari S, Hosseinzadeh H, Dennis S, Zwar N (2020) Activating primary care COPD patients with multi-morbidity through tailored self-management support. npj Primary Care Respiratory Medicine 30, 12
| Activating primary care COPD patients with multi-morbidity through tailored self-management support.Crossref | GoogleScholarGoogle Scholar | 32245961PubMed |
Ansari RM, Harris M, Hosseinzadeh H, Zwar N (2021) Healthcare professionals’ perspectives of patients’ experiences of the self-management of type 2 diabetes in the rural areas of Pakistan: a qualitative analysis. International Journal of Environmental Research and Public Health 18, 9869
| Healthcare professionals’ perspectives of patients’ experiences of the self-management of type 2 diabetes in the rural areas of Pakistan: a qualitative analysis.Crossref | GoogleScholarGoogle Scholar | 34574792PubMed |
Bloom DE, Cafiero ET, Jané-Llopis E, Abrahams-Gessel S, Bloom LR, Fathima S, Weinstein C (2011) The global economic burden of noncommunicable diseases. (World Economic Forum: Geneva, Switzerland) Available at https://world-heart-federation.org/wp-content/uploads/2017/05/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf [Verified May 2021]
Carroll JK, Tobin JN, Luque A, Farah S, Sanders M, Cassells A, Fine SM, Cross W, Boyd M, Holder T, Thomas M, Overa CC, Fiscella K (2019) ‘Get Ready and Empowered About Treatment’ (GREAT) study: a pragmatic randomized controlled trial of activation in persons living with HIV. Journal of General Internal Medicine 34, 1782–1789.
| ‘Get Ready and Empowered About Treatment’ (GREAT) study: a pragmatic randomized controlled trial of activation in persons living with HIV.Crossref | GoogleScholarGoogle Scholar | 31240605PubMed |
Chang YY, Dai YT (2019) The efficacy of a flipping education program on improving self-management in patients with chronic obstructive pulmonary disease: a randomized controlled trial. International Journal of Chronic Obstructive Pulmonary Disease 14, 1239–1250.
| The efficacy of a flipping education program on improving self-management in patients with chronic obstructive pulmonary disease: a randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 31289439PubMed |
Dadich A, Hosseinzadeh H (2013) Healthcare reform: implications for knowledge translation in primary care. BMC Health Services Research 13, 490
| Healthcare reform: implications for knowledge translation in primary care.Crossref | GoogleScholarGoogle Scholar | 24274773PubMed |
Dahal PK, Hosseinzadeh H (2019) Association of health literacy and diabetes self-management: a systematic review. Australian Journal of Primary Health 25, 526–533.
| Association of health literacy and diabetes self-management: a systematic review.Crossref | GoogleScholarGoogle Scholar | 31710832PubMed |
Dwinger S, Rezvani F, Kriston L, Herbarth L, Härter M, Dirmaier J (2020) Effects of telephone-based health coaching on patient-reported outcomes and health behavior change: a randomized controlled trial. PLoS One 15, e0236861
| Effects of telephone-based health coaching on patient-reported outcomes and health behavior change: a randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 32960886PubMed |
Edwards J, Hosseinzadeh H (2018) The impact of structured physical activity on glycaemic control in diabetes prevention programmes: a systematic review. Proceedings of Singapore Healthcare 27, 193–204.
| The impact of structured physical activity on glycaemic control in diabetes prevention programmes: a systematic review.Crossref | GoogleScholarGoogle Scholar |
Eikelenboom N, van Lieshout J, Jacobs A, Verhulst F, Lacroix J, van Halteren A, Klomp M, Smeele I, Wensing M (2016) Effectiveness of personalised support for self-management in primary care: a cluster randomised controlled trial. The British Journal of General Practice 66, e354–e361.
| Effectiveness of personalised support for self-management in primary care: a cluster randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 27080318PubMed |
Furlan AD, Pennick V, Bombardier C, van Tulder M (2009) 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine 34, 1929–1941.
| 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group.Crossref | GoogleScholarGoogle Scholar | 19680101PubMed |
Greene J, Hibbard JH, Sacks R, Overton V, Parrotta CD (2015) When patient activation levels change, health outcomes and costs change, too. Health Affairs (Project Hope) 34, 431–437.
| When patient activation levels change, health outcomes and costs change, too.Crossref | GoogleScholarGoogle Scholar |
Hajat C, Stein E (2018) The global burden of multiple chronic conditions: a narrative review. Preventive Medicine Reports 12, 284–293.
| The global burden of multiple chronic conditions: a narrative review.Crossref | GoogleScholarGoogle Scholar | 30406006PubMed |
Hibbard J (2017) Patient activation and health literacy: what’s the difference? How do each contribute to health outcomes. Studies in Health Technology and Informatics 240, 251–262.
Hibbard JH, Greene J (2013) What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Affairs (Project Hope) 32, 207–214.
| What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs.Crossref | GoogleScholarGoogle Scholar |
Hibbard JH, Mahoney ER, Stockard J, Tusler M (2005) Development and testing of a short form of the patient activation measure. Health Services Research 40, 1918–1930.
| Development and testing of a short form of the patient activation measure.Crossref | GoogleScholarGoogle Scholar | 16336556PubMed |
Ho T, Hosseinzadeh H, Rahman B, Sheikh M (2018) Health literacy and health-promoting behaviours among Australian–Singaporean communities living in Sydney metropolitan area. Proceedings of Singapore Healthcare 27, 125–131.
| Health literacy and health-promoting behaviours among Australian–Singaporean communities living in Sydney metropolitan area.Crossref | GoogleScholarGoogle Scholar |
Hosseinzadeh H, Shnaigat M (2019) Effectiveness of chronic obstructive pulmonary disease self-management interventions in primary care settings: a systematic review. Australian Journal of Primary Health 25, 195–204.
| Effectiveness of chronic obstructive pulmonary disease self-management interventions in primary care settings: a systematic review.Crossref | GoogleScholarGoogle Scholar |
Hosseinzadeh H, Verma I, Gopaldasani V (2020) Patient activation and Type 2 diabetes mellitus self-management: a systematic review and meta-analysis. Australian Journal of Primary Health 26, 431–442.
| Patient activation and Type 2 diabetes mellitus self-management: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 33222755PubMed |
Jeganathan C, Hosseinzadeh H (2020) The role of health literacy on the self-management of chronic obstructive pulmonary disease: a systematic review. COPD 17, 318–325.
| The role of health literacy on the self-management of chronic obstructive pulmonary disease: a systematic review.Crossref | GoogleScholarGoogle Scholar | 32506965PubMed |
Kale MS, Federman AD, Krauskopf K, Wolf M, O’Conor R, Martynenko M, Leventhal H, Wisnivesky JP (2015) The association of health literacy with illness and medication beliefs among patients with chronic obstructive pulmonary disease. PLoS One 10, e0123937
| The association of health literacy with illness and medication beliefs among patients with chronic obstructive pulmonary disease.Crossref | GoogleScholarGoogle Scholar | 25915420PubMed |
Kangovi S, Mitra N, Norton L, Harte R, Zhao X, Carter T, Grande D, Long JA (2018) Effect of community health worker support on clinical outcomes of low-income patients across primary care facilities: a randomized clinical trial. JAMA Internal Medicine 178, 1635–1643.
| Effect of community health worker support on clinical outcomes of low-income patients across primary care facilities: a randomized clinical trial.Crossref | GoogleScholarGoogle Scholar | 30422224PubMed |
Kim SH, Utz S (2019) Effectiveness of a social media-based, health literacy–sensitive diabetes self-management intervention: a randomized controlled trial. Journal of Nursing Scholarship 51, 661–669.
| Effectiveness of a social media-based, health literacy–sensitive diabetes self-management intervention: a randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 31622033PubMed |
Lorig K, Ritter PL, Villa FJ, Armas J (2009) Community-based peer-led diabetes self-management. The Diabetes Educator 35, 641–651.
| Community-based peer-led diabetes self-management.Crossref | GoogleScholarGoogle Scholar | 19407333PubMed |
Lujic S, Simpson JM, Zwar N, Hosseinzadeh H, Jorm L (2017) Multimorbidity in Australia: comparing estimates derived using administrative data sources and survey data. PLoS ONE 12, e0183817
| Multimorbidity in Australia: comparing estimates derived using administrative data sources and survey data.Crossref | GoogleScholarGoogle Scholar | 28850593PubMed |
Lundell S, Holmner A, Rehn B, Nyberg A, Wadell K (2015) Telehealthcare in COPD: a systematic review and meta-analysis on physical outcomes and dyspnea. Respiratory Medicine 109, 11–26.
| Telehealthcare in COPD: a systematic review and meta-analysis on physical outcomes and dyspnea.Crossref | GoogleScholarGoogle Scholar | 25464906PubMed |
Moher D, Liberati A, Tetzlaff J, Altman DG, The PG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine 6, e1000097
| Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.Crossref | GoogleScholarGoogle Scholar | 19621072PubMed |
Niknami M, Mirbalouchzehi A, Zareban I, Kalkalinia E, Rikhtgarha G, Hosseinzadeh H (2018) Association of health literacy with type 2 diabetes mellitus self-management and clinical outcomes within the primary care setting of Iran. Australian Journal of Primary Health 24, 162–170.
| Association of health literacy with type 2 diabetes mellitus self-management and clinical outcomes within the primary care setting of Iran.Crossref | GoogleScholarGoogle Scholar | 29622058PubMed |
Nutbeam D (2008) The evolving concept of health literacy. Social Science & Medicine 67, 2072–2078.
| The evolving concept of health literacy.Crossref | GoogleScholarGoogle Scholar |
Omachi TA, Sarkar U, Yelin EH, Blanc PD, Katz (2013) Lower health literacy is associated with poorer health status and outcomes in chronic obstructive pulmonary disease. Journal of General Internal Medicine 28, 74–81.
| Lower health literacy is associated with poorer health status and outcomes in chronic obstructive pulmonary disease.Crossref | GoogleScholarGoogle Scholar | 22890622PubMed |
Ryvicker M, Feldman PH, Chiu YL, Gerber LM (2013) The role of patient activation in improving blood pressure outcomes in Black patients receiving home care. Medical Care Research and Review MCRR 70, 636–652.
| The role of patient activation in improving blood pressure outcomes in Black patients receiving home care.Crossref | GoogleScholarGoogle Scholar | 23864112PubMed |
Smith SG, Curtis LM, Wardle J, von Wagner C, Wolf MS (2013) Skill set or mind set? Associations between health literacy, patient activation and health. PLoS One 8, e74373
| Skill set or mind set? Associations between health literacy, patient activation and health.Crossref | GoogleScholarGoogle Scholar | 24023942PubMed |
Taggart J, Williams A, Dennis S, Newall A, Shortus T, Zwar N, Denney-Wilson E, Harris MF (2012) A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors. BMC Family Practice 13, 49
| A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors.Crossref | GoogleScholarGoogle Scholar | 22656188PubMed |
United Nations (2017) Population ageing and sustainable development. (UN) Available at https://www.un.org/en/development/desa/population/publications/pdf/popfacts/PopFacts_2017-1.pdf
Westland H, Schuurmans MJ, Bos-Touwen ID, de Bruin-van Leersum MA, Monninkhof EM, Schröder CD, de Vette DA, Trappenburg JC (2020) Effectiveness of the nurse-led Activate intervention in patients at risk of cardiovascular disease in primary care: a cluster-randomised controlled trial. European Journal of Cardiovascular Nursing 19, 721–731.
| Effectiveness of the nurse-led Activate intervention in patients at risk of cardiovascular disease in primary care: a cluster-randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 32375491PubMed |
Yadav UN, Hosseinzadeh H, Lloyd J, Harris MF (2019) How health literacy and patient activation play their own unique role in self-management of chronic obstructive pulmonary disease (COPD)? Chronic Respiratory Disease 16, 1479973118816418
| How health literacy and patient activation play their own unique role in self-management of chronic obstructive pulmonary disease (COPD)?Crossref | GoogleScholarGoogle Scholar | 30789021PubMed |
Yadav UN, Lloyd J, Hosseinzadeh H, Baral KP, Harris MF (2020) Do chronic obstructive pulmonary diseases (COPD) self-management interventions consider health literacy and patient activation? A systematic review. Journal of Clinical Medicine 9, 646
| Do chronic obstructive pulmonary diseases (COPD) self-management interventions consider health literacy and patient activation? A systematic review.Crossref | GoogleScholarGoogle Scholar |
Yang IA, Brown JL, George J, Jenkins S, McDonald CF, McDonald VM, Phillips K, Smith BJ, Zwar NA, Dabscheck E (2017) COPD-X Australian and New Zealand guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2017 update. The Medical Journal of Australia 207, 436–442.
| COPD-X Australian and New Zealand guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2017 update.Crossref | GoogleScholarGoogle Scholar | 29129177PubMed |
Young L, Hertzog M, Barnason S (2016) Effects of a home-based activation intervention on self-management adherence and readmission in rural heart failure patients: the PATCH randomized controlled trial. BMC Cardiovascular Disorders 16, 176
| Effects of a home-based activation intervention on self-management adherence and readmission in rural heart failure patients: the PATCH randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 27608624PubMed |
