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

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.