Introduction
Methods
Search strategy
General queries | Boolean operators |
---|---|
“self-care” OR “self-management” OR “self-awareness” OR “self-testing” OR “self care” OR “self management” OR “self awareness” OR “self testing” | AND |
“caregiver*” OR “carer*” OR “family caregiver*” OR “family carer*” OR “informal caregiver*” OR “informal carer*” OR “spouse caregiver*” OR “spouse carer*” OR “family member*” OR “non-professional care*” or “unpaid care*” | AND |
“randomized controlled trial” OR “randomised controlled trial” OR “randomized and controlled trial” OR “randomised and controlled trial” OR “RCT” OR “pilot randomized controlled trial” OR “pilot randomised controlled trial” OR “pilot RCT” OR “randomized controlled pilot study” OR “randomised controlled pilot study” | AND NOT |
“review” OR “systematic review” OR “meta analysis” OR meta-analysis OR “narrative review” |
Selection criteria
Data extraction
Assessment of risk of bias
Data synthesis and analysis
Results
Selection and characteristics of studies
Author (year), country | Definition of self-care | Self-care category | Study design | Participants | Characteristics of caregiver | Disease | Intervention | Outcome | First outcome measure |
---|---|---|---|---|---|---|---|---|---|
Dionne-Odom (2022), U.S. [36] | Promote and maintain mental health, improve individual capacity | Self-management of health, individual agency, and health information-seeking | Single-blinded, pilot RCT, IG (n = 31), CG (n = 32) | Caregivers | Age: Aged ≥ 18 years; Gender: Female and male; Relationship with patients: Spouse/partner; Parent; Other relative; Friend/other | Cancer | Six weekly 20- to 60-min telehealth coaching sessions plus monthly follow-up for 24 weeks, reviewing skills in stress management, self-care, getting help, staying organized, and future planning | Total distress; anxiety; depression; quality of life | 2 months |
Bijker (2017), Netherlands [26] | Promote and maintain mental health | Self-management of health | Not blinded, pilot RCT, IG (n = 41), CG (n = 39) | Caregivers | Age: Aged ≥ 18 years; Gender: Female and male; Relationship with patients: Parent; Child; Sibling; Other relative; Spouse/partner; Friend; Colleague/classmate; Other | Depressed | Eight nonsequential modules based on psychoeducation and CBT techniques; themes concerned information about depression, suicidality, communication and setting boundaries in caregiving, stress, burnout, and self-care | Primary outcome: User-friendliness; secondary outcomes: psychological distress, anxiety, subjective burden, quality of life, mastery | After intervention |
Leow (2015), Singapore [27] | Promote and maintain mental health, improve individual capacity | Self-management of health, individual agency, social and community support | Not blinded, pilot RCT, IG (n = 38), CG (n = 42) | Caregivers and patients | Age: Aged ≥ 21 years; Gender: Female and male; Relationship with patients: Child; Spouse; Sibling; Parent; Niece; Daughter-in-law; Grandchild | Cancer | Psychoeducational intervention, the Caring for the Caregiver Programme, consisting of a 1-h face-to-face session, a video clip, two follow-up phone calls, and an invitation to an online social support group | Primary outcome: quality of life; secondary outcome: social support, stress and depression, self-efficacy in self-care, closeness with the patient, rewards, and knowledge | 1 month |
Fuju (2021), Japan [28] | Promote and maintain mental health | Self-management of health | Not blinded, RCT, IG (n = 13), CG (n = 13) | Caregivers | Age: NA; Gender: Female and male; Relationship with patients: Husband; Wife; Birth father; Birth mother; Father‐in‐law; Mother‐in‐law | Dementia | Positive diary in which participants wrote down three positive things that happened during the day, with reasons why they chose them, and compliment themselves at the end of each day; content not limited to caregiving | Primary outcome: depression; secondary outcome: quality of life, caregiver burden, positive cognitive appraisal, positive feelings | After intervention |
Behrndt (2019), Germany [29] | Promote and maintain mental health, cope with illness and disability, improve individual capacity | Self-management of health, individual agency | Not blinded, RCT, IG (n = 205, dyadic), CG (n = 154, dyadic) | Caregivers | Age: NA; Gender: Female and male; Relationship with patients: Spouse; son/daughter (in-law); other | Cognitive impairment | Intervention group received counseling in three phone calls focused on stress reduction, development of self-management strategies, and how to deal with challenging behaviors | Primary outcome: subjective burden and depressiveness; secondary outcome: positive aspects of caregiving, health-related quality of life | 6 months |
Boots (2018), Netherlands [37] | Promote and maintain mental health, improve individual capacity | Self-management of health, individual agency | Single-blinded, RCT, IG (n = 41), CG (n = 40) | Caregivers and patients | Age: Aged > 18 years; Gender: Female and male; Relationship with patients: Spouse; other caregivers (e.g., children) | Dementia | 8-week, blended care self-management Partner in Balance program, which combines face-to-face coaching with tailored web-based modules | Primary proximal outcome: self-efficacy; primary distal outcome: depression; secondary outcome: mastery, quality of life, and psychological complaints | After intervention |
Terracciano (2020), U.S. [41] | Promote and maintain mental health, improve individual capacity | Self-management of health, individual agency, health information-seeking | Double-blinded, RCT, IG (n = 37), CG (n = 36) | Caregivers | Age: Aged ≥ 18 years; Gender: Female and male; Relationship with patients: Spouse; child; others | Dementia | Psychoeducational intervention that helps caregivers enhance self-care practices and manage emotional distress | Depressive symptoms, self-efficacy, self-rated health, and life satisfaction | After intervention |
Connell (2009), U.S. [30] | Promote and maintain physical and mental health, improve individual capacity | Self-management of health, individual agency | Not blinded, RCT, IG (n = 86), CG (n = 71) | Caregivers | Age: Aged ≥ 40 years; Gender: Female; Relationship with patients: Wife | Dementia | Intervention group received 14 telephone calls from trained behavior-change counselors for 6 months | Self-rated physical health, count of chronic conditions, physical functioning, objective caregiving burden, exercise behavior, exercise self-efficacy, self-efficacy for self-care, and depressive symptoms | 6 months |
Heckel (2018), Australia [38] | Promote and maintain physical and mental health, improve individual capacity | Self-management of health, individual agency, social and community support, and individual financial transactions for health | Single-blinded, RCT, IG (n = 108, dyadic), CG (n = 108, dyadic) | Caregivers and patients | Age: Aged ≥ 18 years Gender: Female and male; Relationship with patients: Spouse/partner; other (e.g. parent, adult child, friend) | Cancer | Three outcalls from a nurse addressing six topics: psychological distress, health literacy, physical health, family support, financial burden, and practical difficulties (e.g., legal affairs) | Primary outcome: self-reported caregiver burden; secondary outcome: depressive symptoms, unmet needs, self-esteem, self-empowerment, and health literacy | 1 month |
Belle (2006), U.S. [32] | Promote and maintain mental health, cope with illness and disability, improve individual capacity | Self-management of health, individual agency, social and community support, and individual linkage to health system | Not blinded, RCT, IG (n = 323), CG (n = 319) | Caregivers and patients | Age: Aged ≥ 21 years Gender: Female and male; Relationship with patients: Spouse; child; sibling; other | Dementia | Twelve in-home and telephone sessions for 6 months | Primary outcome: quality of life; secondary outcomes: clinical depression and institutional placement of care recipient at 6 months | 6 months |
Nightingale (2022), U.S. [33] | Improve individual capacity | Self-management of health, individual agency, social and community support, and individual linkage to health system | Not blinded, pilot RCT, IG (n = 17), CG (n = 18) | Caregivers | Age: Aged ≥ 18 years; Gender: Female and male; Relationship with patients: Spouse or partner; other family member; friend | Cancer | 6- to 7-week supported self-management intervention offering psychoeducation and stress management skills building. | Feasibility, acceptability, and self-efficacy for caregiving (total score and subscales) | After intervention |
Lewis (2019), U.S. [34] | Improve individual capacity | Self-management of health, individual agency, social and community support | Not blinded, RCT, IG (n = 159), CG (n = 163) | Caregivers and patients | Age: NA; Gender: Male; Relationship with patients: Spouse (husband) | Cancer | Spouses in the experimental group received five 30- to 60-min intervention sessions at 2-week intervals by master’s-level patient educators | Depressed mood, anxiety, cancer-related marital communication, interpersonal support, and self‐care | 3 months |
El-Jawahri (2020), U.S. [35] | Promote and maintain physical and mental health, improve individual capacity | Self-management of health, individual agency | Not blinded, RCT, IG (n = 45), CG (n = 47) | Caregivers | Age: Aged ≥ 18 years; Gender: Female and male; Relationship with patients: Married; child; parent; sibling; divorced | Hematopoietic stem cell transplantation | Caregivers in intervention group met with a trained interventionist in person, via telephone, or via videoconferencing for 6 sessions starting before transplantation and continuing for up to 60 days | Quality of life, caregiving burden, psychological distress, self-efficacy, and coping | 2 months |
Au (2020), Hong Kong [42] | Promote and maintain mental health, improve individual capacity | Self-management of health, individual agency, social and community support | Double-blinded, RCT, IG (n = 37), CG (n = 35) | Caregivers and patients | Age: Aged ≥ 18 years; Gender: Female and male; Relationship with patients: Adult child | Dementia | 8-week intervention: Connecting Through Caregiving with intergenerational perspective-taking reappraisals | Primary outcome: life satisfaction; secondary outcomes: depressive symptoms, burden, perspective-taking reappraisals | 2 months |
Han (2020), Korea [39] | Promote and maintain mental health, improve individual capacity | Self-management of health, individual agency | Single-blinded, RCT, IG (n = 498), CG (n = 471) | Caregivers | Age: Aged ≥ 20 years; Gender: Female and male; Relationship with patients: Spouse; son/daughter in law; other | Long-term care | Eight-week COMPASS program consisting of six individual in-home, three group support sessions, and two telephone sessions with a multicomponent intervention | Primary outcomes: depression, burden, and stress; secondary outcomes: self-efficacy, positive aspects of caregiving, social support, social activities, and health risk behaviors | 2 months |
Hou (2014), Hong Kong [40] | Promote and maintain mental health, improve individual capacity | Self-management of health, individual agency | Single-blinded, RCT, IG (n = 70), CG (n = 71) | Caregivers | Age: Aged ≥ 18 years; Gender: Female and male; Relationship with patients: Spouse; children; parents; relatives | Chronic conditions | Eight weekly 2-h sessions led by trained instructors; participants instructed to do CD-guided home practice for 30–45 min per day | Primary outcome: depressive symptoms; secondary outcome: anxiety symptoms, quality of life, self-efficacy, self-compassion, and mindfulness | After intervention |
Elliott (2010), [31] | Promote and maintain mental health | Self-management of health, individual agency | Not blinded, RCT, IG (n = 257), CG (n = 238) | Caregiver | Age: NA; Gender: Female and male; Relationship with patients: Spouse; nonspouse | Dementia | Nine in-home and three telephone sessions over 6 months in the intervention group. Two brief “check-in” telephone calls during this 6-month period in the control group. | Primary outcome: health status; Secondary outcomes: burden; bother | 6 months |
A’Campo (2010) [43] | Promote and maintain mental health | Self-management of health, individual agency, social and community support | Double-blinded, RCT, IG (n = 26 caregivers), CG (n = 20 caregivers) | Caregivers and patients | Age: NA; Gender: Female and male; Relationship with patients: Partner; close relatives | Parkinson’s disease | Intervention group receive eight weekly standardized Patient Education Program Parkinson (PEPP). Control group receive usual neurological care | Psychosocial problems and need for help due to Parkinson’s disease; health-related quality of life (Hr-Qol); depression | After intervention |
Risk of bias assessment
Definition of self-care
Category of self-care interventions
Results of meta-analysis
Anxiety
Depression
K | SMD | 95% CI | Q | p | |
---|---|---|---|---|---|
Country | |||||
United States | 5 | -0.145 | [-0.311; 0.021] | 16.840 | .009 |
Netherlands | 2 | -0.154 | [-0.542; 0.235] | ||
Hong Kong | 2 | -0.492 | [-0.779; -0.205] | ||
Singapore | 1 | -0.603 | [-1.052; -0.154] | ||
Australia | 1 | 0.150 | [-0.164; 0.463] | ||
Korean | 1 | -0.143 | [-0.288; 0.002] | ||
Japan | 1 | -1.142 | [-2.060; -0.225] | ||
Intervention setting | |||||
Online | 4 | -0.114 | [-0.366; 0.137] | 1.000 | .607 |
Face-to-face | 6 | -0.276 | [-0.586; 0.034] | ||
Combination | 3 | -0.284 | [-0.564; -0.005] | ||
Duration | |||||
< 1 month | 3 | -0.502 | [-0.973; -0.032] | 5.890 | .053 |
1–3 months | 8 | -0.222 | [-0.370; -0.075] | ||
> 3 months | 2 | 0.049 | [-0.181; 0.278] | ||
Caregiver type | |||||
Family | 10 | -0.277 | [-0.408; -0.146] | 9.020 | .003 |
Informal | 3 | 0.177 | [-0.089; 0.443] | ||
Participant type | |||||
Caregivers | 7 | -0.178 | [-0.294; -0.062] | 0.150 | .700 |
Caregivers and patients | 6 | -0.234 | [-0.493; 0.026] | ||
Patient type | |||||
Dementia | 5 | -0.380 | [-0.666; -0.094] | 2.570 | .463 |
Parkinson’s | 1 | 0.100 | [-0.563; 0.763] | ||
Cancer | 5 | -0.119 | [-0.406; 0.167] | ||
No specific disease, in long-term care | 2 | -0.225 | [-0.469; 0.018] | ||
Measures | |||||
CES-D | 10 | -0.196 | [-0.343; -0.050] | 3.800 | .284 |
SDS | 1 | 0.100 | [-0.563; 0.763] | ||
DASS | 1 | -0.603 | [-1.052; -0.154] | ||
HADS | 1 | -0.195 | [-0.690; 0.300] | ||
Measurement time | |||||
Post-intervention | 8 | -0.275 | [-0.467; -0.083] | 1.180 | .881 |
1 month | 2 | -0.209 | [-0.946; 0.528] | ||
2 months | 1 | -0.195 | [-0.690; 0.300] | ||
3 months | 1 | -0.185 | [-0.419; 0.049] | ||
> 3 months | 1 | -0.067 | [-0.403; 0.269] |