Title: A systematic review and meta-ethnography to identify how effective cost-effective accessible and acceptable self-management support interventions are for men with long-term conditions (self-man)
Funder: Department of Health (England)

Abstract: It is clear that the NHS faces significant challenges associated with projected increases in the prevalence of long-term conditions (LTCs) and current demands for up to £20 billion savings. Effective self-management is essential to reducing healthcare costs and optimizing health outcomes for people with LTCs. Interventions have been developed ranging from group patient education to telephone coaching for people with complex needs. Despite a developing evidence-base on the effects of these self-management support interventions major ‘knowledge gaps’ remain especially around ‘what works for whom’. Men have an increased incidence of the most serious and disabling LTCs display poor self-management and are under-represented at self-management support services. These inequalities are not simply the result of biological factors; nor are they intractable. Research into male identity and the management of illness is revealing that preventable risk factors poor engagement in self-management support and reluctance to access existing health services account for a high proportion of mortality and morbidity in men. Yet the effectiveness cost-effectiveness accessibility and acceptability of current self-management interventions for men with LTCs has yet to be established. In the literature on the effectiveness of health interventions a factor that makes an intervention more or less effective is known as a ‘moderator’. The existing data are not available in a form to assess whether gender is a moderator of the effects of self-management interventions and therefore cannot support evidence-based policy making about commissioning services to meet the specific needs of men with LTCs and the legal requirements laid out in the Public Sector Equality Duty. We propose to address this knowledge gap by conducting a comprehensive evidence synthesis involving a systematic review and a meta-ethnography to answer the following research question: How effective cost-effective accessible and acceptable are self-management interventions for men with long-term conditions?1) SYSTEMATIC REVIEW: The significant size and scope of the self-management literature makes a primary review of the evidence to assess the comparative impact of interventions in men an inefficient use of research resources. A scoping search conducted as part of this application suggests that many self-management interventions have already been assessed through existing reviews: we identified over 40 relevant reviews involving over 250 studies in the Cochrane Database for Systematic Reviews. We therefore propose a more efficient and proportionate strategy identifying and locating studies of relevance from existing high quality systematic reviews via the Cochrane Database of Systematic Reviews (CDSR) Database of Abstracts of Reviews of Effects (DARE) and PROSPERO (International Prospective Register of Systematic Reviews). We will search these databases using a range of search terms for self-management and long-term conditions that members of the current team have developed with the Centre for Reviews and Dissemination (CRD) as part of an on-going NIHR-funded project on long-term conditions: http://www.netscc.ac.uk/hsdr/projdetails.php?ref=11-1014-06. To evaluate ‘accessibility’ of interventions we will assess the proportion of eligible patients of each gender being recruited into a trial (where reported in a CONSORT or equivalent) and assess the relative gender proportions in the trial sample compared to what might be expected in terms of the eligible sample or the epidemiology of the disorder. To evaluate effectiveness of interventions we will identify: (a) trials of self-management interventions conducted in males alone; and (b) trials including both genders where secondary analyses have assessed whether the outcomes of self-management interventions are moderated by gender. We will extract data from these studies on populations self-management interventions (including details on components/BCTs and methods and settings of delivery) outcomes and study quality (using Cochrane risk of bias). To evaluate cost-effectiveness we will identify studies that compared costs and effects; a modified version of the drummond checklist will be used to assess quality. We will extract data on resource use (including hospital admissions and attendances as well as primary and community care services) where these provided. Outcomes including health related quality of life will also be extracted (eg EQ5D SF6D) and where Incremental Cost-Effectiveness Ratios (ICERs) are reported we will extract these. If uncertainty around the adoption decision is described by authors we will describe this. Findings will be synthesised across individual studies and reported narratively.2) META-ETHNOGRAPHY:We will search electronic databases Medline Embase PsychINFO Web of Science Social Sciences Citation Index Men’s Bibliography and CINAHL to identify qualitative studies (and mixed methods studies with a qualitative component) which have explored perceptions towards and perceived acceptability of interventions or specific activities and approaches aimed at supporting or promoting self-management of LTCs. Studies that have explored the experiences of men alone or which are a clear and explicit comparison between men and women will be included in the review. Studies which focus on self-management experiences of people with LTCs more generally will be excluded. Studies of interventions delivered to people who do not have a LTC (such as people at risk of a disease or healthy individuals) or who report outcomes for women alone will also be excluded. Qualitative data will be analysed and synthesised according to the meta-ethnography approach described by Noblit and Hare. Data relating to perceptions towards and perceived acceptability of interventions or specific activities aimed at supporting or promoting self-management of LTCs and the influence of age ethnicity and socioeconomic status will be extracted. Key themes metaphors and concepts will be subjected to comparison and synthesis. Design-specific quality appraisal tools will be used to distinguish between studies in terms of overall contribution to the synthesis. The approach will lead to the development of a ‘line of argument’ synthesis which takes into account similarities and differences in the studies to create new models theories and understandings.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;7.3 MANAGEMENT AND DECISION MAKING
Health categories: GENERIC HEALTH RELEVANCE