Barriers and facilitators to self-management of chronic conditions reported by women: a systematic review of qualitative studies

OBJECTIVES
This systematic review aims to identify, appraise and synthesise the findings of published qualitative research exploring the barriers and facilitators to self-management of chronic conditions reported by women.

DESIGN
A systematic literature review and thematic synthesis of qualitative studies.

DATA SOURCES
A search of MEDLINE, CINAHL, Embase and PsycInfo was undertaken using the search terms ‘Women’, ‘Woman’ ‘Female,’ ‘Chronic’, ‘Long-term’, ‘Disease’, ‘Illness’, ‘Condition’ ‘Health,’ ‘Self-management,’ ‘Qualitative,’ ‘Barrier’ and ‘Facilitator’. A hand search for literature was also performed.

ELIGIBILITY CRITERIA
Studies published before 2005 and those not in English were excluded.

DATA EXTRACTION AND SYNTHESIS
Extracted data was analysed thematically and emerging and recurring themes identified. Themes were mapped to the six components of the COM-B model. Critical appraisal of included publications was undertaken using the CASP qualitative checklist and finding weighted upon quality.

RESULTS
Eighty-four publications were identified and eligible for inclusion within the review. Studies were conducted in five continents, with a focus on twenty different chronic conditions and included a total of 1788 women. Barriers and facilitators to physical capability, psychological capability, physical opportunity, social opportunity, autonomic motivation and reflective motivation were identified with a number of recurring themes found. Self-prioritisation, support and culture all had a significant impact upon whether women followed self-management recommendations. Certain groups of women such as those living remotely, those with financial difficulties, migrants and those who do not speak the predominant language appear to face additional barriers to self-management.

CONCLUSIONS
This review highlights that to self-manage chronic conditions women have to overcome various cultural, financial and social barriers. Self-management programs should be designed taking in to account these factors in order to ensure women are better supported and enabled to improve their health outcomes.