SYSTEMATIC REVIEW PROTOCOL

What makes some people with chronic diseases feel healthy? A systematic review of studies with data on self-rated health 

Lead author: Lucia Villa

Co-authors: 

Commenced: July 1, 2013

Lead reviewer’s contact details

Background

Self-rated health assessments, which are frequently included in quality of life studies, are usually obtained by asking people questions such as, “In general, would you say your health is excellent, very good, good, fair, or poor?”. Despite their apparent simplicity, a recent meta-analysis revealed a large body of research suggesting a strong relationship between such assessments and an increased risk of death [1, 2]. On the other hand, practically all studies with self-rating data show that most people with chronic conditions consider their health to be good, very good or excellent. 

Aims of the study and questions

The primary objective of this review is to identify the sociodemographic, lifestyle, disease-related, and psychosocial factors that might explain why some patients living with chronic diseases rate their health as good, very good or excellent, while others consider their health to be fair or poor. The secondary objective is to recognize the factors that lead individuals with the same chronic disease profile to perceive their health status differently.

Study design and Methods

This systematic review will be conducted in compliance with The Cochrane Handbook for Systematic Reviews of Interventions. 

Eligibility Criteria

Titles and abstracts will be screened for eligibility according to the following inclusion and exclusion criteria.

Inclusion criteria

Types of studies: We will include quantitative studies of any design, provided that they report original data from a defined study population.

Types of participants: We will include participants with a clinical diagnosis of one or more chronic diseases.

Types of interventions: This review will include studies with original data on self-rated health assessments, also called self-rated health status, self-rated general health or self-reported health. The data would need to be collected by asking patients a single question such as “In general, how would you rate your health?” or “ In general, how would you say your health is?”.

Types of outcome measures: One of five possible answers to the above questions: excellent, very good, good, fair, or poor.

Search strategy for identification of studies

Databases

The database to be searched will include, but not necessarily be limited to:

- The Cochrane Library

- MEDLINE

- LILACS

- BiblioMap - EPPI-Centre database of health promotion research

- Database of Promoting Health Effectiveness Reviews (DoPHER)

- National Institute for Health and Clinical Excellence (NICE)

We will complement this process with careful screening of the reference lists of eligible reports.

Search Terms for Electronic Databases

The key search terms that will be used to perform electronic database search are the following:

“Self-rated health”, “self-rated health status” “self-rated general health” “self- assessment of health”  “chronic disease” “associated factors” “determinants” modified as necessary according to the database that is being used, and filtered terms related to chronic diseases.

Screening process

Selection of studies (See figure 1) 

Stage 1: The titles and abstracts will be checked independently by two reviewers according to the above inclusion and exclusion criteria and categorized as:included, excluded or undefined. For the articles selected as undefined, the content will be re-evaluated by both reviewers, and if there are discrepancies, a third reviewer will check and categorize the article. Studies that do not fulfill with the inclusion criteria will be excluded. Articles selected as included will be thoroughly reviewed, and subsequently, will be either printed or filed in order to be available for all reviewers at any time. Studies from manual search will be also retrieve and classified asincluded, excluded or undefined by both reviewers. There will be two specific forms for the information obtained from both included and excluded articles (appendix 1).

Stage 2: It will take place after the stage 1 has been completed. Both reviewers who performed the article selection based on titles and abstracts will read the full text of all studies that were included at the stage 1, and those that do not fulfill the eligibility criteria will excluded. Full text of hand search studies will be review according to inclusion and exclusion criteria. The third reviewer will evaluate the full texts that have been categorized differently by the two reviewers (included or excluded).

Figure 1: Flow diagram of study screening process

This flow chart will be given to each reviewer to assure transparency during the review.

Data abstraction and analysis 

The data extraction and collection will be performed by two reviewers who independently will evaluate the relevant information within each study, and subsequently, summarize the data that they consider to be most significant. The data obtained throughout this process will be reported electronically in a structured data collection form to facilitate the data summarization (Appendix 2).  The data collection will be conducted according to the specific characteristics of this review and will include the following items:

• Citation details (lead author's surname, journal and year of publication)
• Population studied (age, sex, race/ethnicity, geographical region, health conditions including diagnosed chronic diseases, comorbidities)
• Study characteristics (objectives, research methods and methodological quality of the study, data analysis, results)
• Type of data – How the self-rated health measure was assessed - reports of participants’ answers to the SRH question
• Associated determinants evaluated in individuals responding the SRH question (gender, age, life history, personal circumstances, stress, economic conditions, education, occupation, marital status, adherence to treatment, developed or developing countries)
• Main findings

After consensus, the data will be entered into the reference tables.

The quality assessment of the included studies will be performed by two reviewers and based on the approach of reporting quality using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a 27-item checklist and a four-phase flow diagram used to improve the quality of data reporting and provide transparency in the conduct and findings of the research (appendix 3).

The data analysis of primary studies will be narrative using subjective methods, but it may involve the manipulation of statistical data when feasible. We decided to used narrative synthesis to approach and synthesize the findings from multiple studies as this systematic review aims mainly to identify and summarize determinants that influence people living with chronic diseases to rate their health status based on the SRH measure, and we will have to handle studies with quantitative, qualitative or mixed results as well as heterogeneity in data reporting and missing data.

Timeframe

The review is expected to take 12 months to complete.

APPENDIX 1

Included studies form

Excluded articles form

APPENDIX 2

Data Collection form

APPENDIX 3

Flow diagram of PRISMA statement

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