Non-Pharmacological Interventions Targeting Sense of Coherence Among Older Adults and Adults With Chronic Conditions: A Meta-Analysis With Trial Sequential Analysis

Abstract

Background: Sense of coherence (SoC) is a core concept of 'salutogenesis' in positive psychology, correlated with emotional distress and disease development in adults with chronic disease and older adults. A diversity of non-pharmacological interventions (NPIs) has been developed to enhance SoC, but research findings are conflicting and the adequacy of sample sizes is uncertainty.

Objective: This paper aimed to explore appropriate interventions, evaluate the effectiveness of these SoC interventions and verify the statistical robustness and reliability of pooled results.

Methods: Search terms including 'sense of coherence' and 'randomised controlled trial (RCT)' were performed in nine electronic databases. Publications were written in English from January 1979 to February 2024. A narrative synthesis was performed to determine intervention details, and classical meta-analysis was used to analyse available data on SoC using RevMan. Besides, trial sequential analysis (TSA) was conducted to verify the robustness of pooled effect size.

Results: Meta-analysis was carried out with 27 RCTs involving 2178 patients. It showed significant effects on SoC compared to usual care among this population for all NPIs at post-intervention and 3-month follow-up. Of these follow-up durations, the effective NPIs were salutogenic-based intervention, self-management intervention, while no significant difference was observed at 6-month or > 6-month follow-up. TSA showed that the significant finding of meta-analysis in salutogenic-based intervention was stable and reliable, while the pooled sample size on self-management intervention was insufficient.

Conclusions: Non-pharmacological (salutogenic-based) interventions could improve SoC among older adults and adults with chronic conditions within 3 months after-intervention. However, its effects were not sustained over a longer period, which further studies will need larger sample sizes to draw definitive conclusions.

Implications for practice: This meta-analysis provided the evidence that salutogenic-based interventions could improve SoC among the target population within 3 months after-intervention, providing a solid foundation for healthcare professionals to base their therapeutic strategies.

Reporting method: The searching results were reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis checklist.

No patient or public contribution: This study is a systematic review with meta-analysis and trial sequential analysis, and the aforementioned details are not applicable to our research.

Trial registration: PROSPERO: CRD42023401215.

Keywords: chronic disease; meta‐analysis; non‐pharmacological intervention; older adults; sense of coherence; trial sequential analysis.

FIGURE 1

The PRISMA flow diagram.

FIGURE 2

Assessment of risk of bias of included studies.

FIGURE 3

The effect of non‐pharmacological interventions on SoC after‐intervention.

FIGURE 4

The subgroup analysis of non‐pharmacological interventions on SoC at different time‐points.

FIGURE 5

The subgroup analysis after sensitivity analysis of non‐pharmacological interventions on SoC at different time‐points.

FIGURE 6

The trial sequential analysis of non‐pharmacological interventions on SoC at different time‐points. 6.1 Within‐1‐month after‐intervention. 6.2 1‐3‐month after‐intervention. 6.3 > 6‐month after‐intervention. 6.4 4‐6‐month after‐intervention. Results: No TSA analysis was conducting at 4–6‐month after‐intervention due to low information use (< 1%).

FIGURE 7

The subgroup analysis of non‐pharmacological interventions on SoC for intervention categories within‐3‐month after‐intervention.

FIGURE 8

The subgroup analysis after sensitivity analysis of non‐pharmacological interventions on SoC for intervention categories within‐3‐month after‐intervention.

FIGURE 9

The trial sequential analysis of non‐pharmacological interventions on SoC at different intervention categories within‐3‐month after‐intervention. 9.1 Salutogenic‐based intervention. 9.2 Cognitive behaviour treatment. 9.3 Self‐management intervention. 9.4 Nurse‐led health education. 9.5 Exercise training.