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Canadian Journal of Cardiology

Resilience in Vulnerable Populations With Type 2 Diabetes Mellitus and Hypertension: A Systematic Review and Meta-analysis

      Abstract

      Background

      Patients with chronic conditions and limited access to health care experience stressful challenges resulting from the burden of managing both their conditions and their daily life demands. Resilience provides a mechanism of adapting to stressful experiences. We conducted a systematic review and meta-analysis to synthesize the evidence about interventions to enhance resiliency in managing hypertension or type 2 diabetes in vulnerable populations and to assess the efficacy of these interventions on clinical outcomes.

      Methods

      We searched multiple databases from early inception through February 2015 including randomized controlled trials that enrolled patients with type 2 diabetes or hypertension. All interventions that targeted resilience in vulnerable populations were included. Data were synthesized to describe the characteristics and efficacy of resiliency interventions. We pooled the total effects by calculating standardized mean difference using the random-effects model.

      Results

      The final search yielded 17 studies. All studies were conducted in the United States and generally targeted minority participants. Resiliency interventions used diverse strategies; discussion groups or workshops were the most common approach.

      Conclusions

      Interventions aimed at enhancing the resiliency of patients from vulnerable groups are diverse. Outcomes were not fully conclusive. There was some evidence that resiliency interventions had a positive effect on hemoglobin A1C levels but not blood pressure. The incorporation of resiliency-oriented interventions into the arsenal of preventing and managing chronic conditions appears to be an opportunity that remains to be better investigated and exploited, and there is need to pursue further understanding of the core components of any intervention that claims to enhance resilience.

      Résumé

      Introduction

      Les patients souffrant de maladies chroniques et ayant un accès limité aux soins de santé affrontent des situations stressantes résultant de la charge à gérer à la fois leurs conditions et les exigences de la vie quotidienne. La résilience procure un mécanisme d'adaptation aux situations stressantes. Nous avons effectué une revue systématique et une méta-analyse afin de synthétiser les données concernant les actions permettant d’améliorer la résilience dans la gestion de l’hypertension ou le diabète de type 2 pour les populations vulnérables et pour évaluer l'efficacité de ces initiatives sur les résultats cliniques.

      Méthodes

      Nous avons recherché de multiples bases de données, de celles de conception précoce jusqu’à février 2015, y compris les essais randomisés contrôlés ayant inclus des patients avec un diabète de type 2 ou une hypertension. Toutes les interventions ciblant la résilience des populations vulnérables ont été incluses. Les données ont été synthétisées afin de décrire les caractéristiques et l'efficacité des actions de résilience. Nous avons regroupé les effets totaux en calculant l’écart moyen normalisé en utilisant le modèle à effets aléatoires.

      Résultats

      La recherche finale a fourni 17 études. Toutes les études ont été menées aux États-Unis et ont généralement ciblé des participants minoritaires. Les interventions de résilience ont usé de diverses stratégies; groupes de discussion ou ateliers ont constitué l’approche la plus commune.

      Conclusions

      Les interventions visant à renforcer la résilience des patients de groupes vulnérables sont diverses. Les résultats n’étaient pas totalement concluants. Il y avait certaines données montrant que les interventions de résilience ont eu un effet positif sur les niveaux d'hémoglobine A1C, mais pas sur la pression artérielle. L’ajout d’interventions axées sur la résilience dans l'arsenal de prévention et de gestion des maladies chroniques semble être une opportunité qui reste à être mieux étudiée et exploitée, et il est nécessaire de pousser plus loin la compréhension des composantes essentielles de toute intervention qui prétend améliorer la résilience.
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