Objective
Behavioral interventions have been used to assist patients in maintaining optimal self-management care of their chronic diseases. However, little is known about the effect of self-management interventions on patient activation for adults with hypertension. Therefore, we conducted a systematic review and meta-analysis to evaluate the effect of self-management strategies on changes in activation levels in adults with hypertension.
Methods
We searched PubMed, CINAHL, and Cochrane Central Register of Controlled Trials from January 1st 2004 to April 1st 2016. The patient activation measure (PAM) was developed in 2004 and we wanted to evaluate activation using the PAM. We included randomized controlled trials aimed at assessing self-management interventions on patient activation in adults with hypertension and also reported patient activation using the PAM. Using a random effects model, we combined the studies to calculate the weighted mean difference of PAM scores between the intervention and the usual care group.
Results
Of 8022 citations, 3 studies (N=1318 participants) met inclusion criteria. In adults with hypertension, self-management interventions improved patient activation with moderate strength of evidence (weighted mean difference=2.11; 95% CI=0.25 to 3.98). A community-based self-management program and motivational interviewing strategies were associated with better improvements in PAM scores compared to usual care. Patients with higher activation levels are more likely to improve their hypertension self-management behaviors.
Conclusions
Behavioral interventions improve patient activation modestly in adults with hypertension. Patient activation can be used as a mechanism to help with hypertension self-management behaviors. These findings reinforce healthcare providers to incorporate these interventions into primary care for patients who have poor hypertension self-management. In addition, healthcare providers should consider that, actively involving adults with poor blood pressure control in the practice of required self-management activities, can prevent hypertension complications and reduce healthcare service utilization. Further research on and interventions for patient activation in adherence to hypertension plans within healthcare settings and diverse communities are needed.
Keywords: adults with hypertension, self-management, and patient activation