The comparative efficacy of comprehensive self-care interventions in chronic illness: An updated meta-analysis of randomized controlled trials.

Background: The efficacy of self-care interventions is not well understood in part because of variation in the domains of self-care being targeted as well as in modes of intervention delivery and behavioral change techniques used in trials. Objective: The goal of this study was to synthesize the efficacy of comprehensive self-care interventions on relevant outcomes across six common chronic illnesses. Design: Meta-analysis, meta-regression, and subgroup comparisons. Methods: Data extraction focused on randomized controlled trials published between 2008 and 2022 designed to enhance comprehensive self-care interventions (i.e. those that focus on all three self-care domains of maintenance, monitoring, and management) in asthma, coronary artery disease, chronic obstructive pulmonary disease, type 2 diabetes mellitus, heart failure, and hypertension. Data were pooled using random-effects meta-analyses. Meta-regression and subgroup analyses were used to quantify the year of publication and both modes of delivery and behavioral change techniques on intervention efficacy, respectively. Results: 145 interventions tested in 140 trials involving 31,642 participants were included. The efficacy of comprehensive self-care interventions on improving outcomes was moderate in effect size and heterogeneous (g = 0.40 (95%CI=0.35-0.45), p < 0.001; χ2=898.7, p < 0.001, I 2=83.9%). In meta-regression, the efficacy of interventions improved linearly between 2008 and 2022 (slope = 0.017 (95%CI=0.001-0.032); z = 2.08, p = 0.038). Interventions using individual face-to-face or telephone modes of delivery, and those employing behavioral feedback, social support or reminders were more efficacious compared with interventions that did not use these features (all p < 0.05). Conclusions: Comprehensive self-care interventions have moderate efficacy in improving outcomes, especially those using certain modes of delivery and behavioral change techniques, and should be considered for adults with chronic illness.