What are the factors that influence the engagement of people with Cystic Fibrosis with web-based self-care management strategies: A Systematic Review.

Title: What are the Factors that Influence the Engagement of People with Cystic Fibrosis (CF) with Web-based Self-Care Management Strategies? A Meta-Aggregative Systematic Review. Background: Medical advances in treatment for people with CF have improved survival rates substantially in the last 30 years. Adherence to complex and onerous medical treatments is essential for this improvement. However, non-adherence to self-care management is high amongst the CF population. Attempts to improve adherence rates are integrating digital technologies and self-care management strategies, with some success. Yet adherence rates remain low and are linked to low engagement rates with the emerging technologies. Aim: The aim of this systematic review was to identify factors that influence engagement of people with CF with web-based self-care management strategies and to present the synthesized findings as guidance for future practice and policy. Methodology: A literature search of six electronic databases, grey literature and hand searching was conducted between January 2000 and March 2018. One reviewer selected for inclusion through screening of the titles, abstracts and full text papers. Two reviewers independently extracted data and assessed for methodological quality. Extracted data was synthesized through meta-aggregation and the two reviewers reached consensus. Results: Eight studies were included. The methodological quality of the studies was assessed as low, yet were included with a weighting score against each finding. Five key themes were extracted: 1. Habit formation 2. CF Team 3. Individualized approach 4. Low level of burden 5. Technology preferences Synthesized findings were developed from these themes and put forward as suggestions to guide clinicians. Conclusions: The results indicated key themes to guide clinicians in promoting engagement with web-based self-care management strategies in people with CF, with the CF teams being the most strongly supported. Quality and strength of evidence was low, but aligned with wider evidence in other long-term conditions. Findings can be considered as guidance for practice but more research is required to allow development of formal policy guidelines