Community Delivered Self-management Programs Mostly Do Not Address Key Domains and Health Determinants: A Call to Action for Improving Chronic Disease Self-management Intervention Design

Objective(s): 1. To assess the current stroke-specific chronic-disease self management programs (CDSMPs) with regard to the Stanford CDSMP domains.
2. To analyze community-based intervention and non-intervention studies targeting persons with stroke (PWS) and stroke caregivers (CG).
3. To identify gaps to inform future stroke CDSMPs using analyses frequencies and patterns of domain inclusion in current stroke CDSMPs.

Data Sources: Customized database searches were run between December 10, 2021, and July 14, 2023 and included CINAHL, Cochrane Library, Embase, JBI Database of Systematic Reviews and Implementation Reports, MEDLINE, PEDro, PLoS, PsycINFO, and Web of Science. In addition, smaller, health-related databases, stroke and rehabilitation journals, gray literature, and stakeholder organization websites were searched. A three-step analysis strategy was used, including citation software to manage indexing and de-duplication, abstract review, and full-text review by two reviewers. Complete information on methodology is described in Schwertfeger, et. al (2020).

Study Selection: Articles were screened by two independent reviewers with disagreements being resolved by a third. Inclusion criteria for participant demographics included those > 18 who are PWS living in the community and their unpaid, informal CGs. Informal CGs are those CGs in the role due to the proximity of their relationship with the PWS. All studies aimed at enhancing post-stroke coping skills were included regardless of intervention, leadership, or setting.

Data Extraction: Data was extracted on a set of a priori elements using the Joanna Briggs Institute System for the Unified Management of the Assessment and Review of Information tool following an iterative 2-reviewer process as described by Peters, et. al (2021)

Data Synthesis: A total of 156 papers from 21 countries published between 1989 and 2023 were included in analysis. 78 studies aimed at PWS, 42 at both CG and PWS, and 36 at CG alone. The CDSMP domain addressed most often was Self-Tailoring (n = 154, 98.7%) and the least often was formation of a patient provider relationship (n = 18, 11.5%). Our analysis of which domains were correlated to co-occur identified that Self-Tailoring—Problem Solving and Resource Utilization—Decision Making were consistently paired in interventions (r=1.000). Conversely, Physical Environment—Problem Solving (r=0.361) and Physical Environment—Self-Tailoring (r =.360) were weakly correlated.

Conclusions: Most CDSMPs for PWS and their CG fail to use peer support, physical environment, and patient-provider relationship. Future interventions aimed at developing post-stroke coping recovery programs should aim to include them.

Author(s) Disclosures: None.