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ComparEuRecommendationsWeb
We suggest the intervention (Conditional recommendation)
In patients with Obesity, the COMPAR-EU Obesity panel, suggests in favour of the use of monitoring, action-based and emotional-based behavioural techniques and social support, rather than usual care
Justification
The COMPAR-EU Obesity panel made a conditional recommendation in favour of Monitoring, action-based ( problem solving and/or goal settings) and emotional-based (coaching, motivation and stress management) behaviouraltechniques and social support, rather than usual care alone, due to a probably favourable balance of effects and cost-effectiveness that probably favours the intervention.
Subgroup considerations
None
Implementation
When implementing SMI in general, the most important contextual factors to keep in mind are:
Healthcare providers’ level: it is important to adapt the advice, communication or intervention to patient’s personal situation and level of knowledge; to have adequate communication skills (for example, show empathy, provide understandable information, ask questions);
Patients’ level: patient’s motivation to engage in self-management; patient’s attitude towards self-management (for example, beliefs about the importance of self-management for health, beliefs about the usefulness of certain self-management tasks).
Interaction level: patients’ preference regarding their own role in treatment (for example, the extent to which a patient wants to be involved in shared decision-making, extent to which a patient expects or wants professional involvement in the daily management of their disease).
When implementing monitoring techniques, the most important contextual factors to keep in mind are:
Healthcare providers’ level: it is important to adapt the advice, communication or intervention to patient’s personal situation and level of knowledge; to be aware of your attitude toward the patients’ knowledge and personal beliefs.
Patients’ level: patient’s motivation to engage in self-management; patient’s attitude towards self-management.
Interaction level:patients’ preference regarding their own role in treatment (for example, the extent to which a patient wants to be involved in shared decision-making, extent to which a patient expects or wants professional involvement in the daily management of their disease).
When implementing action-based behavioural techniques (problem solving and/or goal setting), the most important contextual factors to keep in mind are:
Healthcare providers’ level: it is important to adapt the advice, communication or intervention to patient’s personal situation and level of knowledge;
Patients’ level: patient’s motivation to engage in self-management; patient’s attitude towards self-management (for example, beliefs about the importance of self-management for health, beliefs about the usefulness of certain self-management tasks).
Interaction level: patients’ preference regarding their own role in treatment (for example, the extent to which a patient wants to be involved in shared decision-making, extent to which a patient expects or wants professional involvement in the daily management of their disease).
When implementing Emotional-based behavioural techniques, the most important contextual factors to keep in mind are:
Healthcare providers’ level: it is important to adapt the advice, communication or intervention to patient’s personal situation and level of knowledge; to have adequate communication skills (for example, show empathy, provide understandable information, ask questions);
Patients’ level: patient’s motivation to engage in self-management;
Interaction level: patients’ preference regarding their own role in treatment (for example, the extent to which a patient wants to be involved in shared decision-making, extent to which a patient expects or wants professional involvement in the daily management of their disease).
When implementing Social support the most important contextual factors to keep in mind are:
Healthcare providers’ level: it is important to adapt the advice, communication or intervention to patient’s personal situation and level of knowledge; to have expertise in supporting self-management for chronic diseases;
Patients’ level: (perceived) available support from family and friends; peer support and interaction
SoF
EtD
ComparEuEtdsWeb
| QUESTION | |
|---|---|
| 6. Should monitoring, action-based and emotional-based behavioural techniques and social support vs. usual care be used for adult patients living with obesity? | |
| Population | adult patients living with obesity |
| Intervention | Monitoring, action-based and emotional-based behavioural techniques and social support See more |
| Comparison | Usual Care |
| Main outcomes | Adherence; Blood Pressure - Diastolic Blood Pressure; Blood pressure - Systolic Blood Pressure; Weight management- BMI; Weight management- Body fat; Weight management - waist; Quality of life; Depression; Eating self-efficacy; Exercise self-efficacy; |
| Setting | European Union, outpatient care |
| Perspective | Clinical recommendation- Population perspective |
| Background | Overweight and obesity are chronic metabolic diseases considered as a global public health problem, highly prevalent among adult population (i.e., ̴40%). Obesity increases the risk for many other diseases like diabetes, hypertension, and cancer, thus is a leading cause of disability and death. Some self-management interventions, as behavioural-based weight-loss interventions, have shown more weight loss than usual care and a decreased risk of developing diabetes. However, other health outcomes and long-term effects have been less well reported. Also, the association between weight loss and other health outcomes is still not clear. |
| Conflict of interest |
This work was supported by the EU Horizon 2020 research and innovation programme (grant agreement no. 754936). The funder had no role in developing the protocol or obtaining the results for this study |
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| Priority of problem Is the problem a priority? |
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| JUDGEMENT | RESEARCH EVIDENCE | ||||||||||||||||||||||||
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Overweight and obesity are chronic metabolic diseases considered as a global public health problem, highly prevalent among adult population (i.e., ̴40%). Obesity increases the risk for many other diseases like diabetes, hypertension, and cancer, thus is a leading cause of disability and death. Some self-management interventions, as behavioural-based weight-loss interventions, have shown more weight loss than usual care and a decreased risk of developing diabetes. However, other health outcomes and long-term effects have been less well reported. Also, the association between weight loss and other health outcomes is still not clear. |
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| Desirable Effects How substantial are the desirable anticipated effects? |
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| JUDGEMENT | RESEARCH EVIDENCE | ||||||||||||||||||||||||
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View summary of findings of network meta-analysis
View summary of findings of component network meta-analysis |
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| ADDITIONAL CONSIDERATIONS | |||||||||||||||||||||||||
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The guideline panel has judged thedesirable effects as small
Important outcomes: Fiber consumption (SMD): 0,234 (-0,0667 to 0,5347) Fruit and vegetable consumption (SMD): 0,2343 (-0,0747 to 0,5434) Physical activity (SMD): 0,35 (-0,1205 to 0,8206) Totalsteps (MD): 1824,9 (-1641,4134 to 5291,2134) Carbohydrates (SMD): -0,4346 (-1,3525 to 0,4833) Consumption of fat (SMD): -0,0893 (-0,5184 to 0,3398) Coping with the disease (SMD): -0,0714 (-0,7994 to 0,6565) Dietary habits (SMD): -0,5819 (-0,9159 to -0,2479)
Studies including the intervention: Little-2016 - Dietetic advice to swap foods for similar, but healthier, choices and increase fruit and vegetable intake, in addition to web-based intervention and face-to-face nurse support - 7 individual face-to-face sessions, 24 internet-based contacts - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Self-monitoring
Ross-2012 - Behaviorally based physical activity and diet program implemented entirely within clinical practices - 33 individual face-to-face sessions - Duration 24 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Self-monitoring § Early recognition of symptoms
Bennett-2012 - Behavioral intervention promoting weight loss and hypertension self-management using eHealth components - 12 optional face-to-face group sessions, 18 individual phone calls, internet-based contacts when needed - Duration 24 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Condition-specific behaviours § Self-monitoring § Medication use and adherence § Managing devices
Yin-2018 - Goal-based behavioral intervention with three goals: 5% weight loss, ≥30 min of moderate-intensity steps on most days of the week and a reduction in weekly caloric intake of 1000–1400 calories (200 calories/d) - 22 face-to-face group sessions, 24 individual phone calls when needed - Duration 6 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Condition-specific behaviours § Self-monitoring
Christensen-2013 - Dietary education including self-monitoring of eating habits, dietetics, stimulus control, problem solving, and social support - 52 individual face-to-face sessions - Duration 52 weeks - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours o Clinical management § Self-monitoring
Sellman-2017 - A low-cost obesity recovery network providing ongoing addiction-orientated psychosocial support (Kia Akina) added to the Green Prescription, a key government-funded health promotion programme in New Zealand - Individual/group face-to-face contacts, number unclear; internet-based contacts when needed - Duration 12 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Condition-specific behaviours o Psychological management § Handling/managing emotions
Iriyama-2014 - Nutrition education and the provision of healthy cafeteria meals along with nutritional information for male workers - 9 group/individual face-to-face sessions - Duration 6 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Self-monitoring
Rader-2017 - Face-to-face lifestyle intervention and printed manual on nutrition and exercise needed for behavior change and modification of habits - Phase 1 (Introduction): weekly group sessions; Phase 2/3 (Training/Self-monitoring): printed toolkit/manual - Duration 12 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Psychological management § Handling/managing emotions
Proportion of direct evidence contributing to the final NMA estimate per outcome: - DBP: 85% - SBP: 76% - BMI: 65% - Body fat: 50% - Waist size: 74% - QoL: 100% - Stress: 100% - Eating self-efficacy: 100% - Excercise self-efficacy: 67%
Stress: the components with larger effects are education (E) and social support (SS) Self-efficacy: the components with larger effects are education (E) and emotional-based behavioural techniques and social support (SS)
Modeling estimations for long term consequences We used the COMPAR-EU model developed for the cost-effectiveness analysis to also inform about long-term health outcomes. Decision analysis models estimate provide valuable information for outcomes when empirical evidence is not available or is unfeasible (Trikalinos TA, 2009).
- Years with diabetes: 41 fewer days per person - Quality-Adjusted Life Years (QALY): 28 days of additional life equivalent to full health per person (undiscounted) - Diabetes mellitus: 5 fewer events per 1,000 persons - Myocardial infarction: 2 fewer events per 1,000 persons - Stroke: 2 fewer events per 1,000 persons |
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| Undesirable Effects How substantial are the undesirable anticipated effects? |
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View summary of findings of network meta-analysis
There are no undesirable observed effects. |
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| ADDITIONAL CONSIDERATIONS | |||||||||||||||||||||||||
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The guideline panel judged the undesirable effects as trivial or no effect, or causing no harmful effects except for the potential associated burden of the intervention |
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| Certainty of the evidence What is the overall certainty of the evidence of effects? |
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Very low |
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| ADDITIONAL CONSIDERATIONS | |||||||||||||||||||||||||
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The guideline panel judged the certainty of evidence as very low. |
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| Values Is there important uncertainty about or variability in how much people value the main outcomes? |
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An overview of systematic reviews provided information about how patients value several of the outcomes of interest (critical/important) included in this clinical question:
Abbreviations: CI: confidence interval, EQ5D: EuroQol-5D a Utility values findings were assessed using the GRADE approach guidance (Zang 2019), and for findings assessing the burden for patients, we applied the CERQual approach (https://www.cerqual.org/) 1: Serious risk of indirectness (findings derived from a Japanese population) and imprecision (wide range of values reported). 2: Moderate concerns in the adequacy of findings (scarce and thin data) 3: Moderate concerns in relevance of findings, since these were reported in populations not participating in self-management interventions, they were collected based on general experiences with diabetes management. 4: Serious risk of indirectness regarding how the outcome was assessed, in studies of utility values, exploring the final state of having a specific BMI, and only some studies explored the weight change as BMI excess over 25, reporting it as the value per unit of excess. 5 Moderate concerns in the relevance of findings referred explicitly to adherence to medication (insulin and others) that can be integrated into SM treatment but were not collected from patients who explicitly participated in SM interventions. |
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The guideline panel judged that there is no important uncertainty or variability of how patients value the main outcomes. |
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| Balance of effects Does the balance between desirable and undesirable effects favor the intervention or the comparison? |
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| ADDITIONAL CONSIDERATIONS | |||||||||||||||||||||||||
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The guideline panel judged that the balance of effects probably favorus the intervention. This is due to the small desirable effects, the trivial undesirable effects, the lack of uncertainty and variability of how patients value outcomes, as well as the very low certainty of evidence of effects. |
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| Resources required How large are the resource requirements (costs)? |
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Estimated costs for the intervention across all types of self-management interventions (SMIs), as described in the included studies of the network meta-analysis were on average 438 euros, with a range from 11 to 1565 euros.
Incremental health costs (without the intervention) was 332 euros.
Note: This average/range estimate has been based on 13 cost estimates of SMI for obesity reported in publications. |
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| ADDITIONAL CONSIDERATIONS | |||||||||||||||||||||||||
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The guideline panel considered that the resources required for this intervention varies.
We could not provide cost for any specific type of SMI intervention. Instead the cost described is the average across all the SMIs assessed in the overall network meta-analysis. Costing data for SMIs should be interpreted with caution. We used the data collected from the included studies on the number of sessions, duration of sessions, group size, and primary person performing the intervention to estimate the labor cost of providing the intervention. In many instances, detailed information was missing in the available literature (for example the average group size or duration of sessions). In those cases, we assumed an average of what was reported within a comparison. Some costs were omitted such as information on booklets and other training materials,
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| Certainty of evidence of required resources What is the certainty of the evidence of resource requirements (costs)? |
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The guideline panel has agreed on a very low certainty of the evidence on this domain. |
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| Cost-effectiveness Does the cost-effectiveness of the intervention favor the intervention or the comparison? |
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| JUDGEMENT | RESEARCH EVIDENCE | ||||||||||||||||||||||||
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Estimated costs for the intervention across all types of self-management interventions (SMIs), as described in the included studies of the network meta-analysis were on average 438 euros, with a range from 11 to 1565 euros.
NA: non applicable; QALY: quality adjusted life years; ICER: incremental cost-effectiveness ratio Explanations The cost-effectiveness results are for the UK setting. For more information on the cost-effectiveness analysis and the results for other countries, please see the cost-effectiveness section. The ICER calculation is based on total costs and QALY estimations from the cost-effectiveness analyses. While total cost in the cost-effectiveness analyses exclude intervention costs, a minimum and maximum intervention cost was estimated based on literature and added to the total costs to estimate the ICER. As such, the ICERs indicate the potential range of cost per QALY including intervention cost. |
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| ADDITIONAL CONSIDERATIONS | |||||||||||||||||||||||||
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The guideline panel judged that the cost-effectiveness of this SMI pobably favors the comparison. Overall interpretation should be that it is less likely that these SMIs are cost-effective, because the average cost of SMI for obesity in the literature (438 euro: range 11-1565 euro) are higher than the headroom estimate. The intervention may cost 275 euro maximum to be considered cost-effectiveness, while the majority of SMI programs in the literature cost more.
Given the uncertainty in the cost estimates, it is important to be very cautious when comparing the ICERs (incremental cost-effectiveness ratio) for specific SMIs to the headroom to determine the most efficient intervention.
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| Equity What would be the impact on health equity? |
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The panel agreed that if implemented tailored to culture and health literacy it could increase equity
Equity might be affected by geography and accessibility. |
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| Acceptability Is the intervention acceptable to key stakeholders? |
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The information below has been obtained through an overview of systematic reviews of contextual factors, as well as a scoping review and one overview of systematic reviews of values and preferences. It also includes considerations from a Delphi study that was conducted in COMPAR-EU that included the most important contextual factors for the implementation of components (e.g. groups, peers) of self-management interventions according to stakeholders.
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| ADDITIONAL CONSIDERATIONS | |||||||||||||||||||||||||
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The guideline panel judged that this type of SMI is probably acceptable to key stakeholders.
Studies' Interventions
Iriyama-2014 - Nutrition education and the provision of healthy cafeteria meals along with nutritional information for male workers - 9 group/individual face-to-face sessions - Duration 6 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Self-monitoring
Ross-2012 - Behaviorally based physical activity and diet program implemented entirely within clinical practices - 33 individual face-to-face sessions - Duration 24 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Self-monitoring § Early recognition of symptoms
Little-2016 - Dietetic advice to swap foods for similar, but healthier, choices and increase fruit and vegetable intake, in addition to web-based intervention and face-to-face nurse support - 7 individual face-to-face sessions, 24 internet-based contacts - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Self-monitoring
Yin-2018 - Goal-based behavioral intervention with three goals: 5% weight loss, ≥30 min of moderate-intensity steps on most days of the week and a reduction in weekly caloric intake of 1000–1400 calories (200 calories/d) - 22 face-to-face group sessions, 24 individual phone calls when needed - Duration 6 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Condition-specific behaviours § Self-monitoring
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| Feasibility Is the intervention feasible to implement? |
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| JUDGEMENT | RESEARCH EVIDENCE | ||||||||||||||||||||||||
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The information below has been obtained through an overview of systematic reviews of contextual factors, as well as a scoping review and one overview of systematic reviews of values and preferences. It also includes considerations from a Delphi study that was conducted in COMPAR-EU that included the most important contextual factors for the implementation of components (e.g. groups,peers) of self-management interventions according to stakeholders.
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| ADDITIONAL CONSIDERATIONS | |||||||||||||||||||||||||
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The guideline panel judged that this type of SMI is probably feasible.
This type of SMI are probably more feasible in organizations/settings with a tradition of engaging peers in these type of interventions.
Limited human resources may complicate the implementation of this SMI.
Studies' intervention
- Behavioral intervention promoting weight loss and hypertension self-management using eHealth components - 12 optional face-to-face group sessions, 18 individual phone calls, internet-based contacts when needed - Duration 24 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Condition-specific behaviours § Self-monitoring § Medication use and adherence § Managing devices
Christensen-2013 - Dietary education including self-monitoring of eating habits, dietetics, stimulus control, problem solving, and social support - 52 individual face-to-face sessions - Duration 52 weeks - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours o Clinical management § Self-monitoring
Sellman-2017 - A low-cost obesity recovery network providing ongoing addiction-orientated psychosocial support (Kia Akina) added to the Green Prescription, a key government-funded health promotion programme in New Zealand - Individual/group face-to-face contacts, number unclear; internet-based contacts when needed - Duration 12 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Condition-specific behaviours o Psychological management § Handling/managing emotions
Rader-2017 - Face-to-face lifestyle intervention and printed manual on nutrition and exercise needed for behavior change and modification of habits - Phase 1 (Introduction): weekly group sessions; Phase 2/3 (Training/Self-monitoring): printed toolkit/manual - Duration 12 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Psychological management § Handling/managing emotions
Ross-2012 - Behaviorally based physical activity and diet program implemented entirely within clinical practices - 33 individual face-to-face sessions - Duration 24 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Self-monitoring § Early recognition of symptoms
Little-2016 - Dietetic advice to swap foods for similar, but healthier, choices and increase fruit and vegetable intake, in addition to web-based intervention and face-to-face nurse support - 7 individual face-to-face sessions, 24 internet-based contacts - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Self-monitoring
- Goal-based behavioral intervention with three goals: 5% weight loss, ≥30 min of moderate-intensity steps on most days of the week and a reduction in weekly caloric intake of 1000–1400 calories (200 calories/d) - 22 face-to-face group sessions, 24 individual phone calls when needed - Duration 6 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Condition-specific behaviours § Self-monitoring
Iriyama-2014 - Nutrition education and the provision of healthy cafeteria meals along with nutritional information for male workers - 9 group/individual face-to-face sessions - Duration 6 months - Expected patient (or carer) self-management behaviours: o Lifestyle related behaviours § Eating behaviours § Doing physical activity o Clinical management § Self-monitoring |
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| TYPE OF RECOMMENDATION | ||||
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| Strong recommendation against the intervention | Conditional recommendation against the intervention | Conditional recommendation for either the intervention or the comparison | Conditional recommendation for the intervention | Strong recommendation for the intervention |
| CONCLUSIONS |
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| Recommendation |
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In patients with Obesity, the COMPAR-EU Obesity panel, suggests in favour of the use of Monitoring, action-based ( problem solving and/or goal settings) and emotional-based (coaching, motivation and stress management) behavioural techniques and social support, rather than usual care (conditional, very low certainty of the evidence about the effects). |
| Justification |
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The COMPAR-EU Obesity panel made a conditional recommendation in favour of Monitoring, action-based ( problem solving and/or goal settings) and emotional-based (coaching, motivation and stress management) behaviouraltechniques and social support, rather than usual care alone, due to a probably favourable balance of effects and cost-effectiveness that probably favours the intervention. |
| Subgroup considerations |
|
None |
| Implementation considerations |
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When implementing SMI in general, the most important contextual factors to keep in mind are:
When implementing monitoring techniques, the most important contextual factors to keep in mind are:
When implementing action-based behavioural techniques (problem solving and/or goal setting), the most important contextual factors to keep in mind are:
When implementing Emotional-based behavioural techniques, the most important contextual factors to keep in mind are:
When implementing Social support the most important contextual factors to keep in mind are:
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| Monitoring and evaluation |
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No suggestions. |
| Research priorities |
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Future studies should measure patient important outcomes, both critical and important (list below), have adequate sample size and follow-up, including after the intervention is finished. - Future studies should address also preferences and values of patients in relation to their self management, cost effectiveness and sub-categories of self-monitoring interventions. - Future studies should describe in detail the aspects of the intervention and evalute the long term effectiveness. - Future studies should addresss practical outcomes for patients with obesity, for example, levels of cortisol, inflammation markers and include psychological needs of the patients. - Future studies should address patient's related costs.
Critical outcomes Self-Efficacy Eating self-efficacy Exercise self-efficacy ((Physical activity; Steps per day) Qol (Stress; Depression) Blood pressure (SBP; DBP) Long term complications Weight management (BMI; waist; weight; body fat)
Important outcomes Patient activation Self-monitoring (dietary; weight) Adherence (to medication; to programme) Comorbidities (diabetes) Dietary habits (Dietary habits; Fat consumption, fibre consumption; carbohydrates; fruit and vegetable; consumption of fat) Coping with the disease
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| REFERENCES SUMMARY |
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Summary of findings of network meta-analysis
COMPAR-EU iSoF Web
Summary of findings of component network meta-analysis
Component Network Meta-Analysis:
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| Components's effect (95% Confidence Interval) | CNMA effect (95% Confidence Interval) | ||||
Outcome | E | MT | AB | EB | SS | ||
Stress | -0,9468 (-2,4828 to 0,5892) | 0,1385 (-0,2295 to 0,5064) | 0,1799 (-0,4255 to 0,7852) | 0,8408 (-0,1454 to 1,8271) | -0,6524 (-1,375 to 0,0702) | -0,607 (-1,2151 to 0,0011) | |
Self-efficacy | 0,8434 (0,3176 to 1,3693) | -0,3121 (-0,8024 to 0,1781) | -0,1034 (-0,774 to 0,5671) | 0,2965 (-0,1989 to 0,7919) | 0,2439 (-0,8091 to 1,2969) | 0,5982 (-0,2902 to 1,4866) | |
Components' definition:
E: Education; AB: Action- based behavioural change techniques; EB: emotional-based behavioural techniques; MT:Monitoring techniques; SS: social support
Components
Education (E)
Education (E)
Sharing information. This form of support consists in sharing of information about self-management topics like coping with symptoms, diet, exercise, medication, information about what other people are doing, and information about the disease itself, or about any other relevant aspects that could lead to improved self-management, and ultimately better health. This information can be told or distributed in printed materials like a folder or workbook, or via website or DVD.
Examples: Educational session on healthy eating for people with obesity, provision of a printed leaflet on the importance of foot care in diabetes, or a link to a website with information on chronic obstructive pulmonary disease care.
Monitoring techniques (MT)
Monitoring techniques (MT)
Self-monitoring training and feedback. Training and encouraging people to recognize, monitor, and record behaviours, symptoms, or clinical data. This process may include regular feedback from a clinician, or a synopsis of information registered in a digital tool to encourage you to continue monitoring your illness and behaviours.
Example: Showing a patient how to record blood sugar levels, physical activity, or pain.
Action-based behavioural change techniques (AB)
Action-based behavioural change techniques (AB)
There are different action-based behavioural change techniques:
Enhancing problem-solving skills. This technique consists in teaching on how to analyse factors that influence your behaviour and provide you or help you to develop strategies to reduce or overcome barriers and/or support facilitators (e.g., not eating unhealthy foods when you feel depressed). Strategies include anticipation, self-treatment, resource utilization, and problem management. Ideally, there should be an initial plan, but this is not a requisite.
Example: Identification and attenuation of environmental barriers (e.g., no gym in the neighbourhood when one want to exercise) and facilitators (e.g., someone who keeps you company during exercise) to everyday physical activities.
Goal setting and action planning. This technique consists in encouraging you to set one or more achievable goals based on your needs and preferences. These goals may be behaviours (e.g., a consuming a healthy meal three times a day) or outcomes (e.g., less pain) and can be used as a starting point. The process usually involves the formulation of a detailed action plan, specifying what you would do and at least when and/or where you will do it. It could also include an assessment of your behaviours with your health care provider and a discussion of goals and the writing up of agreed-on action plans, including plans for emergency situations.
Examples of goals: achieving a daily walking distance of 2 km or a weight loss of some kilograms in x months with diet and exercise.
Emotional-based change techniques (EB)
Emotional-based change techniques (EB)
There are different emotional-based behavioural change techniques:
Stress and/or emotional management. This technique consists in helping you to understand the role of stress and emotions and teaching them to use different coping strategies to manage, for example, stress and painful emotions caused by your disease.
Examples: Mindfulness, exercise, stretching, listening to music, deep breathing, or meditation.
Coaching and motivational interviewing. This kind of support helps you to change behaviours by looking what’s important to you, and then offering support, taking into account your needs and preferences. One provider (healthcare professional, peer or lay person) is usually your coach. Motivational interviewing and counselling are included, as well as collaborative conversations with a practitioner, helping with motivation and commitment, minimizing resistance, and resolve ambivalence to change.
Examples: coaching sessions led by a nurse to ease the transition from hospital to home, or rehabilitation programs using coaching methods.
Social support (SS)
Social support (SS)
Helping you to think through how you could obtain social support from others to help them achieve behavioural or outcome goals. It could also include the actual provision of social support or discussions about social support networks suited to your preferences, needs, disease burden, or additional life burdens. Part of this support would include linking you to relevant community services to enhance socialization and make the most of support mechanisms in the local community.
Examples: Encouraging family members to become involved in helping you to manage your disease or encouraging you to participate in a local exercise group.
Individual sessions
A single person receives the self-management support. Examples: self-guided actions (without the participation of any other person) during a clinical visit or within the context of a support or educational session
Face-to-face
Self-management support delivered in a face-to-face encounter between the providers and patients and/or caregivers.
| Körperliche Aktivität [Adipositas] | Lebensqualität - Physische und psychologische Funktionsfähigkeit [Adipositas] | Gewichtsmanagement [Adipositas] | Gesunde Ernährungsgewohnheiten/personalisierte Ernährung [Adipositas] | Kormorbiditätsmanagement [Adipositas] | Umgang mit der Krankheit [Adipositas] | Selbstwirksamkeit [Adipositas] | |
|---|---|---|---|---|---|---|---|
| Techniken zur Eigenüberwachung, handlungs- und emotionsorientierte Verhaltenstechniken und soziale Unterstützung | |||||||
| Siehe praktische Überlegungen. |
Evidence table description for recommendations section
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Praktische Überlegungen
Research priorities
Future studies should measure patient important outcomes, both critical and important (list below), have adequate sample size and follow-up, including after the intervention is finished.
- Future studies should address also preferences and values of patients in relation to their self management, cost effectiveness and sub-categories of self-monitoring interventions.
- Future studies should describe in detail the aspects of the intervention and evalute the long term effectiveness.
- Future studies should addresss practical outcomes for patients with obesity, for example, levels of cortisol, inflammation markers and include psychological needs of the patients.
- Future studies should address patient's related costs.
Critical outcomes
Self-Efficacy
Eating self-efficacy
Exercise self-efficacy ((Physical activity; Steps per day)
Qol (Stress; Depression)
Blood pressure (SBP; DBP)
Long term complications
Weight management (BMI; waist; weight; body fat)
Important outcomes
Patient activation
Self-monitoring (dietary; weight)
Adherence (to medication; to programme)
Comorbidities (diabetes)
Dietary habits (Dietary habits; Fat consumption, fibre consumption; carbohydrates; fruit and vegetable; consumption of fat)
Coping with the disease
Background
Overweight and obesity are chronic metabolic diseases considered as a global public health problem, highly prevalent among adult population (i.e., ̴40%). Obesity increases the risk for many other diseases like diabetes, hypertension, and cancer, thus is a leading cause of disability and death. Some self-management interventions, as behavioural-based weight-loss interventions, have shown more weight loss than usual care and a decreased risk of developing diabetes. However, other health outcomes and long-term effects have been less well reported. Also, the association between weight loss and other health outcomes is still not clear.
