A realist review: what do nurse-led self-management interventions achieve for outpatients with a chronic condition?

Aim: The aim of this study was to examine how nurse-led interventions that support self-management of outpatients with chronic conditions work and in what contexts they work successfully. Background: Self-management could be directed at goals such as quality of life, adherence or patients’ empowerment. Self-management support is an increasingly important task of nurses. Many nurse-led interventions have been developed but it is not clear how these actually help improve patients’ self-management capabilities. Design: Realist review. Data sources: Primary research studies on self-management support interventions conducted by nurses from January 2000 until March 2015 were retrieved from all relevant databases. The studies had a before–after design and used qualitative and quantitative methods. Review methods: For each study, we described how the intervention was supposed to improve self-management and compared this with the empirical evidence. Next, we described the context–mechanism–outcome strings for each separate study, explored patterns and integrated the findings. Results: Thirty-eight papers were included, evaluating 35 interventions concerning a diversity of conditions. Seven different context–mechanism–outcome strings were identified. Interventions focusing on patients’ intrinsic processes were most successful. Least successful were interventions only providing education aimed at patient behaviour change. Various contexts can influence the success of the interventions: involvement of relatives, target group (i.e. chronic condition, motivation, being recently diagnosed or not), involvement of fellow patients and intervention group homogeneity or heterogeneity. Conclusion: Successful interventions focus on patients’ intrinsic processes (i.e. motivation or self-efficacy). This would guide nurses to decide what self-management support intervention they can best use in their specific setting and patient group.