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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Article info
Publication history
Published online: June 16, 2015
Accepted:
June 11,
2015
Received:
May 9,
2015
Footnotes
See page 1186 for disclosure information.
Identification
Copyright
© 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
