Behavioral change in chronic patients educated by nurses in community setting. A systematic review

Background: There is an increasing number of studies reporting educational interventions for chronic patients as a fundamental instrument to engage them and improve their health. The aim of this systematic review was to synthesize evidence about behavioral changes in life style and disease management, assessed with a validated tool, in chronic patients after a structured educational intervention at a community setting level, delivered by a multidisciplinary team including nurses. Methods: A systematic review of the literature was carried out in MEDLINE, Scopus, Web of Science and CINHAL including RCTs, before-after and quasi-experimental studies. Methodological quality of the studies was assessed using Cochrane tools. Results: Of the 7,730 papers initially retrieved, 18 met the inclusion criteria. Studies were mainly conducted in USA, Europe, Asia and Australia. The chronic conditions studied were cardiovascular and respiratory diseases and diabetes with or without comorbidities. Included studies were highly heterogeneous in terms of type of intervention and follow-up duration, that ranged from 8 weeks to 18 months (almost half of the studies lasted no more than 4 months). Globally, 27 tools to assess behavioral changes have been used in the studies, the greatest part of which were disease-specific. Half of the studies showed partial or null efficacy. Almost all the studies showed a high risk of bias (only 3 RCTs had a low risk of bias). Conclusions: There is a general agree about the central role of the nurses in educational intervention of chronic patients at primary care level and the assessment of the behavioral changes with appropriate tools after educational interventions is strongly recommended. However, more efforts are requested in designing studies with an appropriate follow-up and with a standardized system to ascertain the actual behavioral changes, as the last is a strong mean to engage patients in the management of their own disease. Key messages: Nurse educational interventions, in a multiprofessional perspective, make an important contribution to a health behavioral changes in chronic patients in community setting. Well-designed studies, with adequate follow-up and a standardized assessment system are needed to consolidate the engagement of the patients.