Barriers and facilitators influencing self-management among COPD patients: a mixed methods exploration in primary and affiliated specialist care

Abstract

Self-management is becoming increasingly important in COPD health care although it remains difficult to embed self-management into routine clinical care. The implementation of self-management is understood as a complex interaction at the level of patient, health care provider (HCP), and health system. Nonetheless there is still a poor understanding of the barriers and effective facilitators. Comprehension of these determinants can have significant implications in optimizing self-management implementation and give further directions for the development of self-management interventions. Data were collected among COPD patients (N=46) and their HCPs (N=11) in three general practices and their collaborating affiliated hospitals. Mixed methods exploration of the data was conducted and collected by interviews, video-recorded consultations (N=50), and questionnaires on consultation skills. Influencing determinants were monitored by 1) interaction and communication between the patient and HCP, 2) visible and invisible competencies of both the patient and the HCP, and 3) degree of embedding self-management into the health care system. Video observations showed little emphasis on effective behavioral change and follow-up of given lifestyle advice during consultation. A strong presence of COPD assessment and monitoring negatively affects the patient-centered communication. Both patients and HCPs experience difficulties in defining personalized goals. The satisfaction of both patients and HCPs concerning patient centeredness during consultation was measured by the patient feedback questionnaire on consultation skills. The patients scored high (84.3% maximum score) and differed from the HCPs (26.5% maximum score). Although the patient-centered approach accentuating self-management is one of the dominant paradigms in modern medicine, our observations show several influencing determinants causing difficulties in daily practice implementation. This research is a first step unravelling the determinants of self-management leading to a better understanding.

<p>Development and Pretesting of a New Functional-Based Health Literacy Measurement Tool for Chronic Obstructive Pulmonary Disease (COPD) and Asthma Management</p>

“…28,29 We found the results of the needs assessment study were not only useful for guiding the development of our proposed HL tool but also helped to identify possible gaps in respiratory disease management research. Our participants reported several barriers for engaging in selfmanagement practices, which are consistent with those found in the literature; [40][41][42][43] including improper communication with health-care providers and difficulty accessing and understanding health-related information. Utilizing medical jargon and unfamiliar terminology (in verbal or written communication) by health-care providers, in "I don't know that I would talk about diet, and mentioned exercise but not in specifics about I want to do this, so can we come up with a plan for me to be able to stabilize me being active?"…”

“…-Asthma addition to patients' failure to communicate their questions or concerns, were inevitably reported by different studies as major obstacles to appropriate engagement in diseasemanagement process. 41,42,[44][45][46] Around 70% of patients in our study indicated they knew their limitations such as lack of transportation, lack of speaking the same language that the physician, lack of education in their disease, etc., however, many of them also stated they felt reluctant to express their concerns or ask questions, due to the short visit time or attitude of the care provider. In addition, more than half of our study participants reported having low confidence in their health-care provider's interest to listen or respond their questions, preventing proper communication with their care provider.…”

Between hope and hopelessness: COPD patients' and their family members' experiences of interacting with healthcare providers – a qualitative longitudinal study

“…Similarly, receiving personal attention in an atmosphere in which there is enough time taken for the person, apart from their illness, was stressed as important by COPD patients during consultations in a Dutch outpatient clinic and at their general practitioner's surgery. Moreover, they also revealed difficulties in talking about their own goals and troubles in self‐management with healthcare professionals .…”

Necesidades de información en pacientes con enfermedades crónicas. ¿Cómo evitar el ruido en la relación médico-paciente?

“…Autores como Navarro et al (2010) o Ahamad et al (2018) apuestan por identificar las diferencias individuales en dichas necesidades mediante una atención centrada en el paciente y desde un enfoque multidisciplinar. En la misma línea, Hillebregt et al (2017) defienden que deben identificarse aquellas necesidades críticas para cada perfil del paciente según su contexto social, sus habilidades, su estilo de vida, nivel educativo, percepciones de la enfermedad, antecedentes personales, deseos y capacidades.…”