Educational interventions for professionals implementing supported self-management: a systematic review from the IMP2ART programme

Background: Supported self-management improves outcomes for long-term conditions, but implementation is poor. Aim: To synthesise evidence on the effectiveness of educational interventions for professionals supporting self-management amongst people with asthma or diabetes (a comparator long-term condition). Methods: We conducted searches (13 databases; 2 trial registers; citation searching; contact with study authors) to identify randomised controlled trials or controlled clinical trials published 1990 to 2016. Two independent reviewers completed screening, data extraction, and risk of bias assessment (using the Cochrane Tool). We also searched grey literature. A narrative synthesis (informed by the Theoretical Domains Framework) was performed. Results: Of 20,366 identified papers, 31 (21 studies) were included. Risk of bias was unclear in most studies. No diabetes studies improved HbA1c (assessed in 7/8 studies). There were 13 asthma studies: 2/5 studies were effective in increasing action plan provision/ownership. In 5/12 studies, patient outcomes improved. Features of effective interventions included: interactive education, a whole-team focus, opportunities for self-monitoring or reflection, emphasis on positive consequences of support, resources for consultations, and monetary/educational credits. Eight heterogeneous and poorly reported grey literature studies emphasised professional and/or patient involvement in intervention design. Conclusions: Features of effective interventions will be incorporated into a whole systems intervention aiming to embed supported self-management into routine primary care asthma management.