Association between patient activation, self-management behaviours and clinical outcomes in adults with diabetes or related metabolic disorders: a systematic review and meta-analysis protocol.
BMJ Open 2022 ; 12: e056293.
PubMed ID : 35105649
Diabetes and related metabolic disorders such as obesity and cardiovascular diseases (CVD) are a growing global issue. Equipping individuals with the necessary 'knowledge, skills and confidence to self-manage their health' (ie, patient activation (PAct)) may lead to improvements in health outcomes. It is unclear whether existing evidence allows us to assume a causal relationship. We aim to synthesise and critically appraise evidence on the relationship between PAct and self-management behaviours and clinical outcomes of people living with diabetes and related metabolic disorders.
The protocol is based on guidance on Preferred Reporting Items for Systematic Review and Meta-analysis Protocols. We will search Medline, Embase, CENTRAL, PsycInfo, Web of Science and CINAHL using search terms related to PAct, diabetes, pre-diabetes, obesity and CVD. Any quantitative study design is eligible provided studies assess the association between PAct and clinical outcomes and/or self-management behaviours of diabetes and related metabolic disorders. Outcomes include behavioural (eg, diet) and clinical (eg, blood pressure) outcomes. Two reviewers will independently screen titles/abstracts and full texts and assess risk of bias using the revised Cochrane risk-of-bias tool for randomised trials or the Risk of Bias Assessment Tool for Nonrandomised Studies (RoBANS).One reviewer will extract data, with independent checking by a second reviewer. We will critically assess the level of evidence available for assuming a causal association between PAct and outcomes. Data permitting, we will use the Hunter-Schmidt random-effects method to meta-analyse correlations across studies.
Ethical approval is not required. The review will be disseminated in the form of a peer-reviewed journal article, at conferences and other presentations. The findings of the review will be of interest to clinical commissioning groups, policymakers and intervention deliverers/developers.
Background: Diabetes is a growing global issue and is linked to many long-term health problems such as cardiovascular disease. It is important to equip people living with such long-term conditions with the necessary knowledge, skills and confidence to self-manage their health and healthcare. Patients’ knowledge, confidence and skills for self-management are often referred to as ‘patient activation’. Patient activation is frequently measured and used within the NHS.
There are many studies on the relationship between patient activation and health outcomes that are relevant to diabetes and related metabolic disorders (such as obesity and cardiovascular disease). However, this evidence has not been reviewed and summarised in a systematic manner. A systematic review of this literature will help us better understand what ‘patient activation’ actually measures and how this relates to patients’ health and lifestyles.
Aims: The aims of this systematic literature review are to find and summarise evidence on the relationship between patient activation and health outcomes of patients living with diabetes and related metabolic disorders. These health outcomes will include clinical outcomes (such as blood sugar levels) as well as self-management behaviours (such as diet).
Search strategy: We will systematically search scientific databases (such as Medline) as well as some ‘grey literature’ sources (sources that include material not published in academic journals). We will search for studies that report on the relationship between patient activation and health outcomes of diabetes and related metabolic disorders.
Population: We will include studies with adults who have diabetes or a related metabolic disorder. For the purpose of this review, we have defined ‘diabetes and related metabolic disorders’ to include pre-diabetes, diabetes (any type), obesity, and cardiovascular diseases.
Study selection: Two reviewers will independently assess the articles found through our database searches on whether they are eligible for this review. The reviewers will first screen articles based on their titles and content summaries, and then based on their full texts. Only studies considered eligible by both reviewers will be included in the review.
Quality appraisal: The reviewers will independently assess the quality of each article using established ‘risk of bias’ tools.
Data extraction: From each study, we will extract key information that is relevant for this review, such as the statistical results showing the relationship between patient activation and different health outcomes. One reviewer will extract the information and another will check this to ensure it is accurate.Analysis: If possible, we will perform a statistical analysis on the information extracted from the individual studies (‘meta-analysis’), but this will only be possible if the studies are similar enough in their methods. We will also summarise information from the studies descriptively.