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

Materials and methods\r\nA systematic review of the literature was carried out in MEDLINE,\r\nScopus, Web of Science and CINHAL including RCTs, before-after\r\nand quasi-experimental studies. We used PICO strategy and PRISMA\r\nstatement. Methodological quality of the studies was assessed using Cochrane\r\ntools.\r\nResults\r\nOf the 7,730 papers initially retrieved, 14 met the inclusion criteria.\r\nStudies were mainly conducted in Australia (5), USA (4), Asia (3) and\r\nEurope (2). The chronic conditions studied were cardiovascular diseases\r\n(CVD) (6), COPD (3), diabetes (DM) (3) or unspecified chronic conditions\r\n(2). Studied separately in the disease groups, the studies were quite\r\nhomogeneous in terms of type of intervention and follow-up duration,\r\nand only four studies carried out an evaluation post-intervention. Globally,\r\n21 tools have been used to assess behavioral changes, the greatest part\r\nof which were disease-specific. The interventions were effective in the\r\nCVD group, partially effective in DM patients, and completely ineffective\r\nin COPD and multichronic patients. Almost all the studies showed a\r\nhigh risk of bias (only two RCTs were at low risk of bias).\r\nConclusions\r\nThere is a general agreement about the central role of the nurses in\r\neducational intervention of chronic patients at primary care level. The\r\nassessment of the behavioral changes with appropriate tools after educational\r\ninterventions is strongly recommended. Patient education seems\r\nto work, as demonstrated among CV conditions and, in part, in patients\r\nwith diabetes. However, more efforts are needed in designing studies\r\nwith a good methodological quality and an appropriate follow-up.