Special Issue "Implementation of Self-Management Interventions in Chronic Disease Care: Challenges and Lessons Learned"

Special Issue Editors

Dr. Monique Heijmans
E-Mail Website
Guest Editor
Netherlands Institute for Health Services Research, 3513 CR Utrecht, The Netherlands
Interests: self-management; empowerment; chronic diseases; diversity; health literacy; implementation research; gender differences; social capital
Dr. Carola Orrego
E-Mail Website
Assistant Guest Editor
Avedis Donabedian Research Institute, Autonomous University of Barcelona (UAB), Avedis Donabedian Foundation, 08193 Bellaterra, Barcelona, Spain
Interests: patient-centered care; self-management; patient empowerment; patient safety; implementation science; scaling up of interventions; quality improvement

Special Issue Information

Dear Colleagues,

This Special Issue of the International Journal of Environmental Research and Public Health will be devoted to the implementation of effective and/or cost-effective interventions in order to support the self-management of individuals with chronic conditions.

Population ageing and increasing chronic illness burden have sparked interest in innovative care models. Self-management support has been highlighted as a key strategy for addressing chronic disease burdens. Over the last decades, many interventions have been developed so as to support patients and their families with the daily management of their chronic disease.

Self-management interventions are complex interventions. Although there is promising evidence that self-management interventions can improve clinical outcomes and patient-reported outcomes, such as quality of life, self-efficacy, or adherence in numerous chronic conditions, these interventions often get stuck in the phase of research, do not get structurally implemented in healthcare, or do not reach the patient groups that need them the most.

Traditional methods of review focus on measuring and reporting on intervention effectiveness; often end with evidence that is mixed or conflicting; and provide little or no clue as to why the intervention worked or did not work when applied in different contexts or circumstances, deployed by different stakeholders, or used for different purposes or outcomes.

Therefore, a better understanding of the facilitators and barriers to successful implementation of (cost-) effective self-management interventions is essential. Contextual factors at various levels (system, organisation, patient–provider interaction, and patient) can all influence SMI uptake, engagement, and success. Improving our understanding of how these factors influence the effectiveness and cost-effectiveness of SMIs for chronic illness is urgently needed.

We encourage you to submit original empirical studies, as well as systematic reviews, realist reviews, or meta-analyses. Short reports and methodological papers will also be considered. In particular, we encourage the submission of interdisciplinary work and multi-country collaborative research, as well as manuscripts that address (but are not limited to) the implementation of self-management interventions, applied to the following fields:

  • Hard to reach populations (e.g., people with limited health literacy, people living in rural or remote areas, minority groups, or people with less social or financial resources)
  • Multidisciplinary settings
  • People suffering from co-morbidity and multi-morbidity
  • Descriptions of development, validation, or the evaluation of self-management interventions in health care and the community in which the implementation factors are addressed
  • Empirical studies (quantitative, qualitative, and mixed methods) applied to any subject related to self-management interventions (broadly defined) in high- and/or low-resource environments.


Dr. Monique Heijmans
Dr. Carola Orrego
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.


  • Chronic diseases
  • Self-management
  • Complex interventions
  • Contextual factors
  • Implementation research

Published Papers (1 paper)

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To Adapt or Not to Adapt: The Association between Implementation Fidelity and the Effectiveness of Diabetes Self-Management Education
Int. J. Environ. Res. Public Health 2021, 18(8), 4095; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18084095 - 13 Apr 2021
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Self-management education (SME) is a key determinant of diabetes treatment outcomes. While SME programs are often adapted for implementation, the impact of adaptations on diabetes SME effectiveness is not well documented. This study evaluated the impact of the implementation fidelity of diabetes SME [...] Read more.
Self-management education (SME) is a key determinant of diabetes treatment outcomes. While SME programs are often adapted for implementation, the impact of adaptations on diabetes SME effectiveness is not well documented. This study evaluated the impact of the implementation fidelity of diabetes SME programs on program effectiveness, exploring which factors influence implementation fidelity. Data from 33 type 2 diabetes SME program providers and 166 patients were collected in 8 countries (Austria, Belgium, Germany, Ireland, UK, Israel, Taiwan and USA). Program providers completed a questionnaire assessing their adherence to the program protocol and factors that influenced the implementation. Patients answered a pre–post questionnaire assessing their diabetes-related health literacy, self-care behavior, general health and well-being. Associations between implementation fidelity and outcomes were estimated through logistic regressions and repeated measures MANOVA, controlling for potential confounders. Adaptations of the program protocol regarding content, duration, frequency and/or coverage were reported by 39% of the providers and were associated with better, not worse, outcomes than strict adherence. None of the factors related to the participants, facilitating strategies, provider or context systematically influenced the implementation fidelity. Future research should focus on individual and contextual factors that may influence decisions to adapt SME programs for diabetes. Full article

Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

1. Title: "Why do people with severe mental illness have poor cardiovascular health? – the need for implementing a recovery-based self-management approach"

Authors: Sara Zabeen, Sharon Lawn, Anthony Venning, Kate Fairweather-Schmidt

Affiliation: College of Medicine and Public Health, Flinders University, SA, Australia

Abstract: People with severe mental illness (SMI) die significantly earlier than their well counterparts, mainly due to preventable chronic conditions such as cardiovascular disease (CVD). Based on the existing research, this paper summarises the key contributors to CVD in people with SMI to better target the areas that require more attention to tackle this deplorable health inequity. We discuss five broad factors that, according to current international evidence, are believed responsible for the development and sustainment of CVD in people with SMI: 1) bio-psychological and lifestyle-related factors; 2) socio-environmental factors; 3) health system-related factors; 4) service culture and practice-related factors; and 5) research-related gaps on how to improve cardiovascular health of those with SMI. This paper shows that CVD in people with SMI is a multi-faceted problem involving a range of risk factors. The existing Chronic Care Model or clinical Recovery model alone is insufficient to address this complex problem. Furthermore, none of these models have identified the significant roles that family caregivers play in improving a person’s self-management behaviours. Therefore, this paper proposes a new framework to resolve this complex health issue that warrants a collaborative approach within and between different health and social care sectors.

Keywords: severe mental illness; cardiovascular disease; comorbidity; chronic condition self-management; recovery

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