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Objective: To quantify diversity in components of self-management interventions and explore which
components are associated with improvement in health-related quality of life (HRQoL) in patients with
chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD), or type 2 diabetes mellitus
(T2DM).
Methods: Systematic literature search was conducted from January 1985 through June 2013. Included
studies were randomised trials in patients with CHF, COPD, or T2DM, comparing self-management
interventions with usual care, and reporting data on disease-specific HRQoL. Data were analysed with
weighted random effects linear regression models.
Results: 47 trials were included, representing 10,596 patients. Self-management interventions showed
great diversity in mode, content, intensity, and duration. Although self-management interventions
overall improved HRQoL at 6 and 12 months, meta-regression showed counterintuitive negative effects
of standardised training of interventionists (SMD =
0.16, 95% CI: 0.31 to 0.01) and peer interaction (SMD = 0.23, 95% CI 0.39 to 0.06) on HRQoL at 6 months.
Conclusion: Self-management interventions improve HRQoL at 6 and 12 months, but interventions
evaluated are highly heterogeneous. No components were identified that favourably affected HRQoL.
Standardised training and peer interaction negatively influenced HRQoL, but the underlying mechanism
remains unclear.
Practice implications: Future research should address process evaluations and study response to selfmanagement on the level of individual patients