Supporting self-management for people with hypertension: a meta-review of quantitative and qualitative systematic reviews

Orjola Shahaj, Diarmuid Denney, Anna Schwappach, Gemma Pearce, Eleni Epiphaniou, Hannah Parke, Stephanie Taylor, Hilary Pinnock

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    Abstract

    OBJECTIVES: Globally, healthcare policy promotes supported self-management as a strategy for people with long-term conditions. This meta-review aimed to explore how people with hypertension make sense of their condition, to assess the effectiveness of supported self-management in hypertension, and to identify effective components of support. METHODS: From a search of eight databases (January 1993-October 2012; update June 2017) we included systematic syntheses of qualitative studies of patients' experiences, and systematic reviews of randomized controlled trials evaluating the impact of supported self-management on blood pressure and medication adherence. We used meta-ethnography, meta-Forest plots and narrative analysis to synthesise the data. RESULTS: Six qualitative and 29 quantitative reviews provided data from 98 and 446 unique studies, respectively. Self-management support consistently reduced SBP (by between 2 and 6 mmHg), and DBP (by between 1 and 5 mmHg). Information about hypertension and treatment, home BP monitoring (HBPM) and feedback (including telehealth) were widely used in effective interventions. Patients' perceptions of a disease with multiple symptoms contrasted with the professional view of an asymptomatic condition. HBPM, in the context of a supportive patient-professional relationship, changed perceptions of the significance of symptoms and fostered confidence in ability to self-manage hypertension. CONCLUSION: Our systematic qualitative and quantitative meta-reviews tell complementary stories. Supported self-management can improve blood pressure control. Interventions are complex and encompass a broad range of support strategies. HBPM (with or without telehealth) within the context of a supportive patient-professional partnership can bridge the gap between medical and lay perspectives of hypertension and enable effective self-management.

    Original languageEnglish
    Pages (from-to)264–279
    Number of pages16
    JournalJournal of Hypertension
    Volume37
    Issue number2
    Early online date30 Jul 2018
    DOIs
    Publication statusPublished - Feb 2019

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    Keywords

    • Hypertension
    • systematic meta-review
    • Randomised controlled trial/RCT
    • Qualitative
    • Systematic Review
    • long term conditions
    • Self-management
    • Blood Pressure
    • medication adherence
    • Telehealth
    • Meta-analysis
    • meta-ethnography
    • Qualitative synthesis

    ASJC Scopus subject areas

    • Health Professions(all)
    • Medicine(all)
    • Psychology(all)
    • Social Sciences(all)

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