Self-management interventions for adults with chronic diseases who have limited health literacy in high, middle, and low-income countries: A scoping review

BACKGROUND: Tailored self-management interventions to address the disparities in health outcomes faced by patients with chronic diseases and limited health literacy (HL) are critical. Therefore, an appropriate self-management intervention framework is needed to guide the development and implementation of interventions. The purpose of this review was to summarize the self-management interventions available in high, middle, and low-income countries for adults with chronic diseases who possibly had limited HL. METHODS: This scoping review searched 13 electronic databases (PubMed, Academic Search Ultimate, Africa-Wide Information, APA PsycArticles, APA PsycInfo, CINAHL with Full Text, Communication & Mass Media Complete, ERIC, Health Source: Consumer Edition, Health Source: Nursing/Academic Edition, Humanities Source Ultimate, MEDLINE, Sociology Source Ultimate) without language or time restriction. A piloted data-charting form was used, and the charted data were analyzed according to population, concept, and context (PCC) frequency counts. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist was used as a reporting guide. RESULTS: A total of 13 studies with 3522 participants met the inclusion criteria. The majority of studies had been conducted in high-income countries, using either randomized controlled trials (RCTs) or quasi-experimental designs. The most common types of chronic diseases in the studies were diabetes and chronic pulmonary disease/asthma. Four main types of self-management interventions were identified, and the types varied by administration settings. Underpinning frameworks, timeframes, presenters, outcomes, and recommendations were found to vary across the types of interventions. CONCLUSION: No specific evidence of self-management interventions for adults with chronic diseases and possibly limited HL was found in low and middle-income countries by this review. Evidence from high-income countries refers to four main types of interventions that should be considered when developing interventions targeting similar population groups. Further primary research in low and middle-income countries is recommended.