Table 2. Quality ratings of included studies.
| Colorectal Cancer | |||
|---|---|---|---|
| Country & Setting (*Quantitative design) [reference] | Study design and sample | Mean quality rating (maximum score 22) | Extracted self-management outcomes |
| UK, Community [50] | Focus groups with colorectal cancer survivors (n = 40) (P) | 14 | Coping with fatigue—Coping with fear of recurrence—Coping with Sexual dysfunction—Improving mobility—Coping with bowel symptoms—Wanting clarity of information-Returning to previous self |
| UK, Cancer centre [67] | Longitudinal Qualitative design. Individual interviews pre and 6mths post chemotherapy treatment (n = 11) (P) | 10.5 | Managing symptoms—Being resilient for treatment- Not letting treatment/side effects interfere with life—Prevent reoccurrence—Maintain health-To be in control |
| UK, Cancer centre [60] | Individual interviews pre and 6mths post chemotherapy treatment (n = 11) (P) | 10.5 | Manage treatment/symptoms—Prevent complications-To be as fit as possible—Maintain a sense of ‘normality’ |
| USA, Cancer clinics [62] | Semi-structure interviews with cancer free adults, treated for Colorec Ca in the pre 0–24 months (n = 41) (P) | 12 | Gain and maintain general fitness-Reduce risk of reoccurrence—Improve chances of recovery—Prevent/ stop complications-Control pain—To return to pre-cancer life-To address lifestyle issues (diet, smoking, weight, exercise) |
| Diabetes | |||
| UK, 4 universities [92] | Semi-structured interviews and diaries. University students (n = 17, aged 18–25yrs) with T1DM (P) | 9 | Regulate blood sugar—Reduce risk of complications—Take part in social activities without complications—Feel good about selves—Feeling normal |
| USA, Health centre [71] | 2 FGs with HCPs—nurses, educators, physicians, paraprofessionals, outreach workers, nurse practitioners, physicians assistants (n = 15) 4 FGs with Latino adults 30–79 yrs old with T2DM (n = 37) (HCP, P) | 12 | Diet and exercise to control blood sugar (HCP)–Control blood pressure (HCP)—To improve quality of life (P)—Prevent deterioration of condition (P)—Stay healthy (P) |
| Ireland, GP practices and hospital diabetic clinics [93] | In-depth open ended interviews. Adults with type I or II DM (n = 17) (P) | 12 | Control blood sugar—Maintain a healthy weight |
| UK, GP surgeries [94]* | RCT. Video SM inter v. control group >18 yrs, newly diagnosed DM within previous 6/12s (n = 42) (HCP) | 10 | HbA1c—Body weight- Lipid profile—Improve quality of life- Improve dietary intake-Improve physical activity |
| USA, General internal medicine and endocrinology clinics of University hospital [68] | Secondary analysis of in-depth interviews Older (>65yrs) adults with T2DM (n = 28) (P) | 7 | To be able to walk—Maintain independence—Prevent complications/slow deterioration—Control blood glucose level—To feel good |
| UK, Diabetes Education network database [95] | Interviews with specialist nurses and dieticians (n = 5) (HCP) | 10 | Prevent complications—To feel competent-To feel confident—Improve mental and emotional wellbeing—Improve quality of Life—HbA1C |
| Sweden, Primary Health centre [66] | Structured conversation. T2DM adults (at least 1 year, 55–75yrs), & who ‘followed a diet and tablet or insulin regime’ (n = 8) (P) | 3 | Maintain stable blood sugar level—Regulate diet and exercise—Knowledge about blood glucose management |
| Canada, Community health centres and diabetes education centres [96] | Semi-structured interviews. T2DM English speaking adults (>18yrs) not using insulin, who monitored their BG levels, and self-identified as being of Black Caribbean or South Asian ethnicity (P) | 12 | Control blood sugar level—Prevent complications |
| USA, Community health centres (CHCs) [97]* | Quasi-experimental. Non-randomised evaluation of impact of community health workers on Diabetes SM v. non- participating CHCs (HCP) | 10.5 | Control blood sugar—Maintain biomedical markers (HbA1c, lipid profile, blood pressure)—To keep appointments—To have a healthy diet—To monitor blood glucose-To exercise |
| USA, Community [63] | Semi-structured interviews. African- American (n = 20) & Latino adults (n = 20) (38–72 yrs) with DM and had completed or were active in a Community Health Worker-led diabetes self-management program (P) | 12 | Control blood sugar—Prevent complications—Build confidence—To live longer and more healthily—Have hope—To enhance emotional support |
| Canada, Rural community-based chronic disease management Program [58] | Exploratory qualitative study. Interviews with DM patients who had received health coaching for ≥6 sessions (n = 3) (P) | 5.3 | To be healthy-To increase life expectancy—Lose weight—Feel in control of condition—To have good mood—To manage independently from HCPs |
| USA, City medical centre clinics [57] | In-depth interviews. Grounded theory approach >65yrs, T2DM plus 1 additional risk factor (n = 28) (P) | 11 | Maintain independence—Lose weight—Prevent complications—Control sugar levels—Stay healthy- Remaining independent—Staying alive |
| USA, Public health clinics [48] | Exploratory descriptive design. Interviews with adult Mexican-Americans with T2DM (n = 51). Interviews with HCPs from public health clinics and community health centres (n = 36) (P) | 10 | Control of blood sugars (HCP)—To have long-term health (HCP)—To have appropriate helpful information (P)—To manage blood sugars (P)- To looking after yourself to the best of your ability (P) |
| Taiwan, 3 teaching hospitals [69] | Focus groups (n = 5). Adults >20yrs, with T2DM, for >5yrs, (n = 41) (P) | 11 | To ‘cure’ diabetes-Control sugar levels-Achieve a balanced life (social-emotional wellbeing)—To consult professionals—To live a healthy life |
| Thailand, Urban communities [65] | Semi-structured. 1:1 interviews conducted in Thai. Thai Buddhist adults (>20yrs) with T2DM, able to read and write (n = 30) (P) | 12.5 | Control blood sugar—Maintain health—Prevent complications |
| USA, City clinics that serve the uninsured and under-insured [51] | Focus groups (n = 12). >18 yrs, English or Spanish speaking African American & Mexican Americans T2DM (n = 84) (P) | 11 | Lose weight—Avoid complications—Reduce health care costs—Manage sugar levels- To feel good—Maintain physical function- Reduce stress- Have control over treatment |
| USA, Urban medical university [75] | Focus Group (n = 6). Black women with T2DM (n = 7) (P) | 6 | Prevent complications-Improve Knowledge-Avoid deterioration—Not be reliant on poor professional knowledge |
| Denmark, RCT study population [64] | Focus groups (n = 7). T1 or T2DM (30–72yrs) who had participated in a 4 day SMI, or were about to participate in the SMI (n = 22) (P) | 11.6 | Control blood glucose level—Prevent complications—To feel confident-To fully participate in ‘normal’ life—Ability to manage condition yourself—A family that supports dietary changes |
| USA, Outpatient clinics [73] | Qualitative in-depth interviews. T2DM, >55yrs, having hypertension plus one other co-morbidity (n = 24) (P) | 8 | Maintain physical function-To feel good—To maintain independence—Maintain health—To live longer-To be able to take part in social activities-Lose weight—Maintain blood sugar levels-Improve diet & exercise-Avoid complications |
| Ireland, 5 DafNE study sites [98] | Interviews, Adults (>20yrs) with T1DM, a range of time since diagnosis, age and gender (n = 40). (P) | 11.5 | Avoid hypoglycaemia—Reduce worry/stress—Prevent complications- Gain knowledge-Improving HBa1C |
| USA, Community [49]* | Quasi-experimental DSM educational intervention v. conventional DSMI T2DM for at least 1yr, >40yrs (n = 33) (HCP & P) | 8 | Prevent complications (HCP)—Prevent deterioration of health (HCP)—Increase diabetes knowledge (HCP)—Psychosocial adaption to diabetes (HCP)—Increase empowerment (HCP)—Increase self-care activities (HCP)—Learn how to follow the self-care recommendations (P)—Prevent & deal with complications (P) |
| Scotland, 16 general practices and 3 hospital clinics, in 4 local health cooperatives [99] | Longitudinal interview study (time 2 interview 6/12s later) T2DM diagnosed within the previous 6 months (n = 40) (P) | 11.5 | Manage sugar levels—Prevent complications—Manage independent of Health professionals—Knowledge to act upon blood glucose readings |
| Switzerland, Outpatient clinics and GP practices [100]* | Self-report Questionnaire. Importance of 16 treatment goals rated on a scale plus level of importance participants perceived their HCP also attributed to goals T1 (n = 297)or T2DM (n = 205), German speaking (HCP & P) | 11 | Control blood sugar levels (HCP)-Quality of life (HCP)—Reduce weight (HCP)—Reduce daily hassles (HCP)—Develop treatment goals (HCP)—Reduce frequency of hypos (HCP)—High quality of life (P)—Weight reduction/maintenance (P)-Avoidance of daily hassles (P)—Gain good medical care and knowledge (P) |
| USA, 3 rural counties [74] | In-depth interviews (n = 63) using semi-structured guide. African American, American Indian and white Adults (>60yrs) with DM (1 or 2) for at least 2 yrs. (P) | 11.5 | Avoid complications (amputations, coma, blindness)—Control blood sugar levels- Avoid hypoglycaemia |
| Australia, Inner city, university hospital outpatient clinic and a support group website [101] | Semi-structured interviewsEnglish speaking young adults (18–38yrs) with T1DM (n = 20) (P) | 10 | Control glycaemic changes- Minimise risks associated with fluctuating BG—Improve Knowledge—Avoid complications |
| Norway, 2 Hospital Trusts [59] | Semi-structured interviews and Focus groups (n = 2) Adults, T2DM, who’d been to GP in past 3 yrs (n = 23) and who’d attended educational group programs (P) | 11 | Live a ‘normal’ life—Avoid complications—Lose weight—Have more energy—Increase well-being |
| Norway, Hospital Trust [102] | Semi-structured interviews Adults with T2DM about to undergo DSMI (n = 22) (P) | 8.6 | Maintain a balanced diet—Stabilise blood glucose—Manage side effects of medications—To be more relaxed—Manage/ prevent complications—Lose weight—Physical function–Knowledge—Gain reassurance—Be more active |
| Iran, Clinic (unspecified) [55] | Focus groups (n = 6) Adults withT2DM >6/12s (n = 43) (P) | 14.5 | Control blood sugar levels—Avoid complications—To be fit in order to care for family—To fulfil religious obligations—To be able to access to equipment—To have knowledgeable health professionals |
| UK, Community urban and rural areas [53] | Focus groups Adults with T2DM (2 FGs with newly diagnosed, 2 FGs with new oral therapy, 2 FGs with new insulin therapy) (P) | 11 | Manage diet—Emotional and social wellbeing—Lose weight—Professionals that are motivational and proactive—To gain knowledge |
| Not specified [54] | ‘Think aloud’ technique– 3 sessions where all thoughts, decisions and impressions related to DM over a 1 week period were recorded (self). Adult experts in T1DM decision-making (diagnosed for ≥15 yrs) (n = 22)(P) | 11.3 | Control blood glucose levels- Avoid complications—Prevent hypoglycaemia and hyperglycaemia—Ability to have a good quality of life—To develop skills to manage diabetes |
| Sweden, Unspecified setting [103] | Content analysis of 3 open-ended questions, 12, 24 and 3–7 yrs following participation in a DSMI T2DM participated in a year-long experience based group education program (n = 139)(P) | 9.5 | Manage blood glucose- Avoid going onto medications—Avoid complications—Prevent worsening of condition—Maintain a healthy weight—Get satisfying support from professionals |
| USA, Urban community health clinic [72] | Focus groups (n = 6) Latino adults with T2DM 18–70yrs (n = 20) & their caregivers (n = 20) (P) (F) | 10.5 | Prevent complications—Reduce stress—To gain glycaemic control—Avoid complications—Develop coping strategies |
| Stroke | |||
| UK, SM training programme for health professionals [70] | Case reflections. In-depth case reflections (n = 60) of therapists and nurses working in inter-professional stroke teams across the UK (HCP) | 10 | Self-efficacy—Achieve goals which are important to the patient |
| UK, Database of therapists trained in a SM approach [61] | Semi-structured interviews. Therapists trained in a SM approach (n = 11) and working in stroke in acute, community & rehab settings (HCP) | 12.6 | Make impairments better—Achieve good long-term health—Achieve goals which are important to the patient |
| Netherlands, Community [56] | Focus groups. Stroke survivors > 3/12s post-stroke, living in the community and discharged following rehab (n = 16) (P) | 11 | To recover (to be previous self)—Adjust to impairment—Gain help and support—Manage mood and emotions |
| USA, Two rehabilitation hospitals [52]* | Survey. Survey of self-care needs of stroke survivors from perspectives of family members (n = 166)(F) | 6 | Prevent falls—Stay active—Manage stress levels—Deal with emotional and mood changes—To increase dexterity, memory and function—Prevent complications—Improve communication—Maintaining adequate nutrition—Manage roles and relationships—Understand stroke—Deal with behaviour and personality changes—Learn about exercise/activity/rest |
* (P)- Patient, (F)- Family and Friends (HCP) Health Care Professional