Comorbid distress in adolescents and young adults with physical long-term conditions (LTCs) is common but can be difficult to identify and manage. Self-directed self-management interventions to reduce distress and improve wellbeing may be beneficial. It is unknown, however, which intervention characteristics are successful in supporting young people. This rapid review aimed to identify characteristics of self-directed self-management interventions that aimed, in whole or part, to address distress, wellbeing or self-efficacy in this population.
A systematic search was conducted for relevant controlled studies in six databases. Data on study setting, population, intervention characteristics, outcome measures, process measures and summary effects were extracted. Risk of bias was assessed using Cochrane Risk of Bias tool v1, and strength of evidence rated (informed by GRADE). PPIE members supported the review process including interpretation of results. The rapid review was registered with PROSPERO (ID: CRD42021285867)
Fourteen studies were included, all of which were randomised trials. Heterogeneity was identified in health conditions targeted; type of intervention; outcome measures; duration of intervention and follow-up. Three had distress, wellbeing or self-efficacy as their primary outcome. Four modes of delivery were identified across interventions ─ websites, smartphone applications, text messages and workbooks; and within these, 38 individual components. Six interventions had a significant benefit in mental health, wellbeing or self-efficacy; however, intervention characteristics were similar for beneficial and non-beneficial interventions.
There is a paucity of interventions directly targeting distress and wellbeing in young people with physical LCTs. In those identified, heterogeneity of interventions and study design makes it difficult to identify which characteristics result in positive outcomes. We propose the need for high quality, evidence-based self-management interventions for this population; including 1) more detailed reporting of intervention design, content and delivery; 2) robust process evaluation; 3) a core outcome set for measuring mental health and wellbeing for self-management interventions; and 4) consistency in follow up periods.
Seven young people with a LTC were involved throughout the rapid review, from the development of the review protocol where they informed the focus and aims, with a central role in the interpretation of findings.
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