Self-care Behaviours and Technology utilised during COVID-19:Systematic Review (Preprint)

BACKGROUND Self-care behaviours are essential for people living with chronic conditions. However, the outbreak of the COVID-19 pandemic has imposed additional complications into their daily routines. Few studies have analysed how self-care behaviours have changed during COVID-19 and the role of digital technology, especially amongst people with chronic conditions. OBJECTIVE This study aimed to review how self-care behaviours have changed for people with chronic conditions during the COVID-19 pandemic, and what technology they have adopted to manage their conditions during that period. METHODS A systematic review was conducted using narrative synthesis. Data were extracted from PubMed, MEDLINE, Excerpta Medica database (EMBASE), PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google Scholar, included studies from December 2019 onwards. Eligible studies focused on adults diagnosed with chronic conditions undertaking any self-care tasks in line with the middle-range theory of self-care of chronic illness (i.e. self-care maintenance, monitoring, and management). Methodological quality of included articles were assessed with a modified version of McMaster Critical Review Forms for Quantitative or Qualitative studies. RESULTS In total, 36 primary research articles were included. Changes to self-care behaviours during COVID-19 amongst people with chronic conditions were organised according to middle-range theory of self-care of chronic illness focusing on self-care maintenance (i.e. medication adherence, physical activity, diet control), self-care monitoring (i.e. monitoring signs and symptoms), and self-care management (i.e. consultations with health care providers). Positive self-care behaviours observed include: individuals trying to maintain good glycaemic control during COVID increased their medication adherence in 27% of studies, and diet control improved in 50% of studies. Negative self-care behaviours observed include: decline in physical activities and increased sedentariness observed in 65% of studies; poor diet control in 57% of studies, and self-monitoring of health status dropped in 43% of studies. Use of technology to support self-care of chronic conditions during COVID were reported in 26 studies. Actual utilisation of telehealth in place of physical consultations during COVID was observed in 50% of studies and other digital technology (e.g. social media apps, smartphone apps, online platforms, web browsing )were used in 50% of studies. Telehealth was discussed and recommended as the default technology in delivering future health care services during COVID-19 and beyond in 77% of studies. CONCLUSIONS The review highlighted the necessity to re-think how models of self-care should continue to address the demands of chronic conditions while being responsive to the imminent threats of infectious diseases. Perhaps the silver lining of COVID-19 is that adoption of digital technology (especially telehealth) amongst a vast cross-section of people with chronic conditions is possible. Future research should investigate effective ways to incorporate evidence-based digital health tools into these new models of self-care that address the challenges of chronic and infectious conditions.