Self-management of non-communicable diseases in low- and middle-income countries: A scoping review

• Published in: PloS one 2019-07, Vol.14 (7), p.e0219141-e0219141
• Main Authors: Hearn, Jason, Ssinabulya, Isaac, Schwartz, Jeremy I, Akiteng, Ann R, Ross, Heather J, Cafazzo, Joseph A
• Format: Article
• Language: English
• Subjects: Analysis; Biology and life sciences; Biomedical engineering; Biomedical materials; Cardiovascular disease; Cardiovascular diseases; Care and treatment; Cell Phone; Citation management software; Clinical trials; Communicable diseases; Congestive heart failure; Developing Countries; Diabetes; Diabetes mellitus; Diabetes Mellitus - therapy; Disease control; Disease management; Engineering and Technology; Epidemiology; Glucose; Health care networks; Heart failure; Heart Failure - therapy; Hemoglobin; Humans; Hypertension; Hypertension - therapy; Income; Internet; Interoperability; Intervention; Low income groups; Management; Medical devices; Medical electronics; Medical equipment; Medicine and Health Sciences; Methods; Noncommunicable Diseases - therapy; Poverty; Public health; Quality of Life; Scaling; Self management (Psychology); Self-Management - methods; Short message service; Smartphones; Socioeconomics; Studies; Sustainability; Sustainable development; Telemedicine - methods; Telephone calls; Text Messaging
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0219141

The prevalence of non-communicable diseases (NCDs) is rising in low- and middle-income countries (LMICs). Self-management, which enables patients to better manage their health, presents a potentially-scalable means of mitigating the growing burden of NCDs in LMICs. Though the effectiveness of self-management interventions in high-income countries is well-documented, the use of these strategies in LMICs has yet to be thoroughly summarized. The purpose of this scoping review is to summarize the nature and effectiveness of past interventions that have enabled the self-management of NCDs in LMICs. Using the scoping review methodology proposed by Arksey and O'Malley, PubMed was searched for relevant articles published between January 2007 and December 2018. The implemented search strategy comprised three major themes: self-management, NCDs and LMICs. Thirty-six original research articles were selected for inclusion. The selected studies largely focused on the self-management of diabetes (N = 21), hypertension (N = 7) and heart failure (N = 5). Most interventions involved the use of short message service (SMS, N = 17) or phone calls (N = 12), while others incorporated educational sessions (N = 10) or the deployment of medical devices (N = 4). The interventions were generally effective and often led to improvements in physiologic indicators, patient self-care and/or patient quality of life. However, the studies emphasized results in small populations, with little indication of future scaling of the intervention. Furthermore, the results indicate a need for further research into the self-management of cardiovascular diseases, as well as for the co-management of diabetes and cardiovascular disease. Self-management appears to be an effective means of improving health outcomes in LMICs. Future strategies should include patients and clinicians in all stages of design and development, allowing for a focus on long-term sustainability, scalability and interoperability of the intervention in the target setting.