Identifying components of self-management interventions that improve health-related quality of life in chronically ill patients: Systematic review and meta-regression analysis

•We systematically reviewed self-management interventions for patients with chronic conditions.•Intervention components were compared to identify the most effective components.•The interventions showed great diversity in mode, content, intensity, and duration.•No components were identified with a favourable effect, but standard training and peer interaction showed a negative effect.•Process evaluations of interventions will help to understand the success of self-management

ObjectiveTo quantify diversity in components of self-management interventions and explore which components are associated with improvement in health-related quality of life (HRQoL) in patients with chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD), or type 2 diabetes mellitus (T2DM).MethodsSystematic literature search was conducted from January 1985 through June 2013. Included studies were randomised trials in patients with CHF, COPD, or T2DM, comparing self-management interventions with usual care, and reporting data on disease-specific HRQoL. Data were analysed with weighted random effects linear regression models.Results47 trials were included, representing 10,596 patients. Self-management interventions showed great diversity in mode, content, intensity, and duration. Although self-management interventions overall improved HRQoL at 6 and 12 months, meta-regression showed counterintuitive negative effects of standardised training of interventionists (SMD = −0.16, 95% CI: −0.31 to −0.01) and peer interaction (SMD = −0.23, 95% CI: −0.39 to 0.06) on HRQoL at 6 months.ConclusionSelf-management interventions improve HRQoL at 6 and 12 months, but interventions evaluated are highly heterogeneous. No components were identified that favourably affected HRQoL. Standardised training and peer interaction negatively influenced HRQoL, but the underlying mechanism remains unclear.Practice implicationsFuture research should address process evaluations and study response to self-management on the level of individual patients.