Impact of educational interventions on behavioral changes in chronic patients educated by nurses in community setting. Evidence from a systematic review.

Materials and 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. We used PICO strategy and PRISMA statement. Methodological quality of the studies was assessed using Cochrane tools. Results Of the 7,730 papers initially retrieved, 14 met the inclusion criteria. Studies were mainly conducted in Australia (5), USA (4), Asia (3) and Europe (2). The chronic conditions studied were cardiovascular diseases (CVD) (6), COPD (3), diabetes (DM) (3) or unspecified chronic conditions (2). Studied separately in the disease groups, the studies were quite homogeneous in terms of type of intervention and follow-up duration, and only four studies carried out an evaluation post-intervention. Globally, 21 tools have been used to assess behavioral changes, the greatest part of which were disease-specific. The interventions were effective in the CVD group, partially effective in DM patients, and completely ineffective in COPD and multichronic patients. Almost all the studies showed a high risk of bias (only two RCTs were at low risk of bias). Conclusions There is a general agreement about the central role of the nurses in educational intervention of chronic patients at primary care level. The assessment of the behavioral changes with appropriate tools after educational interventions is strongly recommended. Patient education seems to work, as demonstrated among CV conditions and, in part, in patients with diabetes. However, more efforts are needed in designing studies with a good methodological quality and an appropriate follow-up.