Table 2.

Pre-post, within-subjects comparison trials of self-management health care models for individuals with serious mental illnesses included in the review

Study	Intervention description	Sample	Design	Self-management	Main health outcomes
Chiverton et al., 2007 (31)	Classroom-based intervention featuring psychiatric nurses with case management experience delivered in 16 training sessions that address client assessment, education, and support in major areas of wellness and diabetes self-management. Patients are taught about lifestyle; stress management; proper medication usage; use of a glucometer; skin, foot and eye care; and community resources.	74 participants; mean age=46; 32% male; 58% white; 34% African American, 8% unidentified; psychiatric conditions, substance use disorders, episodic mood disorder, schizophrenia, and personality disorders	Pre-post pilot, within-subjects comparison over 16 total sessions (duration not specified)	None reported	Mean health risk status, measured with the Gordon Personal Health Analysis, improved significantly from baseline to program completion (p<.001). The hemoglobin A1C level declined significantly after the program (p<.05).
Lawn et al., 2007 (22)	The 6-month study used 2 generic approaches to self-management support: all received the Flinders clinician-administered care planning approach, which provides self-management support, linkage to resources, and active management of patient-provider relations; and 17 received the Stanford model, a peer-led, 6-week education course that teaches self-management (3 attended only the Stanford groups).	38 participants; 55% female (mean age=46); 45% male (mean age=39); psychiatric conditions, schizophrenia, schizoaffective disorder, bipolar disorder, anxiety, major depression, personality disorders, and PTSD	Pre-post pilot, within-subjects comparison over 6 months	Patients' Partners in Health (PIH) scores showed significant change on all self-management parameters (knowledge, life-style choices, and managing the impact of their condition). At 6 months, a significant relationship was noted between the PIH knowledge subscale and the SF-12 physical functioning subscale.	No significant change was noted in the SF-12 physical summary scores. A case note audit showed that no patients required hospitalization during the study period, and patients had fewer hospital admissions 12 months after study participation compared with 12 months before (not significant).
Lorig et al., 2014 (26)	Peer-led, classroom-based, 6-session trainings over 6 months that focus on self-management education and chronic disease management and feature weekly action planning and feedback on progress toward self-management and problem solving	139 participants; M±SD age=48.2±11.0; 24% African American; 27% male; psychiatric conditions, depression, bipolar disorder, schizophrenia, and schizoaffective disorder	Pre-post, within-subjects comparison over 6 months	None reported	At 6 months, 8 of 10 health indicators (for example, fatigue, quality of life, health distress, bad physical health days, and bad mental health days) and health behaviors (communication with a physician and adherence to medical care) improved significantly. None of the 4 medical utilization measures changed significantly.
Sajatovic et al., 2011 (35)	Nurse and peer-led training in illness management adapted to the primary care setting for persons with serious mental illnesses and diabetes, which includes 2 phases: 12 weekly group sessions lasting 60-90 minutes and 4 weekly telephone follow-up sessions	12 participants; median age=49.5; all had type 2 diabetes; psychiatric conditions, DSM-IV diagnosis of serious mental illness (schizophrenia or schizoaffective disorder, bipolar disorder, and major depressive disorder)	Pre-post pilot, within-subjects comparison over 16 weeks	None reported	At week 16, hemoglobin Ale had improved at clinically significant levels for 8 participants (67%, mean=.83±.74), 1 participant maintained controlled diabetes, and 3 had slightly increased hemoglobin Alc. Weight loss was insignificant, but significant improvement was noted in dietary behaviors.