Smart health technologies have been increasingly used in chronic disease management, and become an important way foroptimizing the health management behaviors in patients with chronic diseases. Based on a review of studies about healthcare-seeking behaviors in Chinese patients with chronic diseases and the framework of the Andersen's Behavioral Model of Healthcare Utilization, we summarized that healthcare-seeking behaviors in these patients are associated with predisposing, enabling, and need factors, with enabling factors (economic status and education level) being the key determinant. Therefore, it is necessary to utilize the advantages of care delivery modes using smart health technologies to integrate media resources for health knowledge education, strengthen the social support for vulnerable groups and optimize the cooperation between multiple care delivery groups. The implementation of these strategies will contribute to the empowerment of people with chronic diseases, optimizing their healthcare-seeking behaviors, and making effective use of health service resources.
Nudge theory is an emerging behavioral intervention theory based on behavioral economics and positive psychology, which has been widely used and proven effective in chronic disease self-management abroad. Compared with traditional intervention methods for chronic disease self-management, nudge theory-based intervention program possesses stronger generalization owing to lower requirements for patients' knowledge and attitude regarding chronic disease self-management without interfering with their freedom of choice. We introduced the concept, mechanism of action and classification of nudge theory, and reviewed the advances in its application in chronic disease self-management from four aspects: symptom monitoring, diet control, physical exercise, and medication adherence. On this basis, we put forward the following recommendations to ensure the effectiveness of nudge theory-based interventions: developing nudge theory-based intervention programs targeting the barriers to chronic disease self-management, delivering different types of interventions to different patients using digital technology as a method for classifying the intervention program, having close contact with the community during the intervention, and strengthening the supervision of relevant departments.
In China, chronic diseases have become a major public health problem threatening residents' health. Highlighted in the national policies, primary care settings should act as the "main battlefield" for fighting chronic diseases.
To understand the topics, hot spots and development trends in chronic disease management in primary care of China, providing evidence for further research.
In September 2021, relevant literature of chronic disease management in primary care in China were searched in databases of SinoMed, CNKI, Wanfang Data, and CQVIP from inception to September 13, 2021. Endnote X9 was used to conduct statistical analysis of the annual number of publications, distribution of journals, and distribution of institutions.VOSviewer 1.6.14 was adopted for high-frequency keywords analysis, network analysis of keyword co-occurrence, timeline view of keyword co-occurrence network, and visualizing the knowledge map.
In total, 4 060 articles published since 1977 (as of September 13, 2021) were included. The annual number of published articles demonstrated an upward trend in general. The journal with the highest number of articles was Chinese General Practice〔329 articles (8.10%) 〕. Fudan University was the most prolific institution〔1.75% (71/4 060) 〕. The top 10 high-frequency keywords were chronic diseases〔8.75% (895/10 224) 〕, community〔7.49% (766/10 224) 〕, elderly people〔4.90% (501/10 224) 〕, diabetes〔4.62% (472/10 224) 〕, hypertension〔4.28% (438/10 224) 〕, chronic obstructive pulmonary disease〔4.22% (431/10 224) 〕, prevalence〔4.04% (413/10 224) 〕, influencing factors〔3.29% (336/10 224) 〕, risk factors〔2.60% (266/10 224) 〕 and quality of life〔1.95% (199/10 224) 〕. Four major hot topics were identified by network analysis of keyword co-occurrence: chronic disease management of the elderly in the community, epidemiology of risk factors for chronic diseases, management and community-based comprehensive prevention and treatment regarding chronic diseases (such as hypertension and diabetes) , community-based nursing and rehabilitation of chronic diseases (mainly for chronic obstructive pulmonary disease) . Hierarchical diagnosis and treatment and contracted family doctor services, informationization and Internet-based services, mental or sleep health, multimorbidity, general practitioner and pharmaceutical care were recently emgerged research themes identified by timeline view of keyword co-occurrence network.
The number of studies about of chronic disease management in primary care in China demonstrated an overall upward trend, with management of hypertension, diabetes, and chronic obstructive pulmonary disease in primary care as the research hotspots. Studies on hierarchical diagnosis and treatment and contracted family doctor service, informationization and Internet-based services, mental or sleep health, multimorbidity, and general practitioner and pharmaceutical care are in the ascendant.
