Supporting self-management for people with hypertension: A meta-review of quantitative and qualitative systematic reviews

Orjola Shahaj, Diarmuid Denneny, Anna Schwappach, Gemma Pearce, Eleni Epiphaniou, Hannah L Parke, Stephanie J C Taylor, Hilary Pinnock

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Objectives: Globally, healthcare policy promotes supported self-management as a strategy for people with long-term conditions. This meta-review aimed to explore how people with hypertension make sense of their condition, to assess the effectiveness of supported self-management in hypertension, and to identify effective components of support.

Methods: From a search of eight databases (Jan 1993-Oct 2012; update June 2017) we included systematic syntheses of qualitative studies of patients’ experiences, and systematic reviews of randomised controlled trials evaluating the impact of supported self-management on blood pressure and medication adherence. We used metaethnography, meta-Forrest plots and narrative analysis to synthesise the data.

Results: Six qualitative and 29 quantitative reviews provided data from 98 and 446 unique studies, respectively. Self-management support consistently reduced systolic BP (by between 2 and 6mmHg), and diastolic BP (by between 1 and 5mmHg). Information about hypertension and treatment, home BP monitoring (HBPM) and feedback (including telehealth) were widely used in effective interventions. Patients’ perceptions of a disease with multiple symptoms contrasted with the professional view of an asymptomatic condition. HBPM, in the context of a supportive patient professional relationship, changed perceptions of the significance of symptoms and fostered confidence in ability to self-manage hypertension.

Conclusions: Our systematic qualitative and quantitative meta-reviews tell
complementary stories. Supported self-management can improve blood pressure control. Interventions are complex and encompass a broad range of support strategies. Self-management support for hypertension 3 HBPM (with or without telehealth) within the context of a supportive patient-professional
partnership can bridge the gap between medical and lay perspectives of hypertension and enable effective self-management.
Original languageEnglish
JournalJournal of Hypertension
Early online date16 Jul 2018
DOIs
Publication statusE-pub ahead of print - 16 Jul 2018

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