Decades of Research in the Chronic Disease Self-Management Program: A Systematic Review and Meta-Analysis of...

Background. The evidence-based Chronic Disease Self-Management Program (CDSMP) has been widely implemented and adapted globally for decades, yet no comprehensive analysis of its outcomes after 2009 has been published to date, to our knowledge. Objectives. This systematic review and meta-analysis aimed to assess the long-term (6 months after the intervention) impact of CDSMP on participants' well-being across countries and to identify key elements for effective future implementation and adaptation. Search Methods. We conducted a systematic review (1978-2024) and meta-analysis (October 2009-2024), excluding studies previously synthesized in a 2013 meta-analysis covering January 1999 to September 2009. We identified literature through a structured 3-stage process: database searches (PubMed, Web of Science, Scopus), examination of sources listed by the Self-Management Resource Center, and targeted follow-up based on initial findings. Selection Criteria. We included peer-reviewed studies evaluating the CDSMP with follow-up data at least 6 months after the intervention, involving adults with chronic conditions. Data Collection and Analysis. Two reviewers independently extracted data. A random-effects meta-analysis was performed on outcomes measured 6 months after the intervention, including sleep problems, pain, and fatigue (all assessed using a visual analog scale), as well as depressive symptoms (Patient Health Questionnaire-9). Main Results. We retrieved a total of 6565 articles, of which 228 were included in the systematic review and 20 in the meta-analysis. Participants included in the studies most frequently reported diseases such as hypertension, heart disease, cardiovascular disease, stroke, inflammatory diseases, and metabolic diseases. The mean difference between participants' pain scores before and 6 months after the program was 0.53 (95% confidence interval [CI] = 0.24, 0.83); for depression, 1.47 (95% CI = 1.04, 1.90); for fatigue, 0.46 (95% CI = 0.28, 0.65); and for sleep problems, 0.57 (95% CI = 0.28, 0.85). Conclusions. Six months after completing the program, a decreasing trend in sleep problems, depressive symptoms, pain, and fatigue persists among program participants in different countries. A significant challenge identified across the reviewed studies was securing sustainable funding and ensuring effective recruitment and retention of participants, which requires diverse outreach strategies to reach target populations. The findings also reveal an emerging profile of participants who benefit most from the program. Public Health Implications. The sustained outcomes position the CDSMP as an effective, scalable, and universally relevant tool for improving chronic disease management and symptom control. The systematic review indicates that individuals with multimorbidity benefit to a greater extent from the program. Nonetheless, increased emphasis on standardized outcome measures is needed to improve cross-study comparability and support more robust conclusions. (Am J Public Health. 2026;116(9): 1397-1408. https://doi.org/10.2105/AJPH.2025.308381).