Facilitators and barriers to the self-management of COPD: a qualitative study from rural Nepal

Abstract

ObjectiveTo understand the facilitators and barriers to the self-management of chronic obstructive pulmonary disease (COPD) in rural Nepal.SettingsCommunity and primary care centres in rural Nepal.ParticipantsA total of 14 participants (10 people with COPD and 4 health care providers) were interviewed.Primary and secondary outcome measure(s)People with COPD and healthcare provider’s experience of COPD self-management in rural Nepal.ResultsFacilitators and barriers affecting COPD self-management in Nepal operated at the patient-family, community and service provider levels. People with COPD were found to have a limited understanding of COPD and medications. Some participants reported receiving inadequate family support and described poor emotional health. At the community level, widespread use of complementary and alternative treatment was found to be driven by social networks and was used instead of western medicine. There were limited quality controls in place to monitor the safe use of alternative treatment. While a number of service level factors were identified by all participants, the pertinent concerns were the levels of trust and respect between doctors and their patients. Service level factors included patients’ demands for doctor time and attention, limited confidence of people with COPD in communicating confidently and openly with their doctor, limited skills and expertise of the doctors in promoting behavioural change, frustration with doctors prescribing too many medicines and the length of time to diagnose the disease. These service level factors were underpinned by resource constraints operating in rural areas. These included inadequate infrastructure and resources, limited skills of primary level providers and lack of educational materials for COPD.ConclusionsThe study findings suggest the need for a more integrated model of care with multiple strategies targeting all three levels in order to improve the self-management practices among people with COPD.

Community health workers for non-communicable disease prevention and control in Nepal: a qualitative study

“…A number of key barriers both at systems and service delivery levels in Nepal were identified: (1) lack of appropriate NCD policy guidelines, (2) insufficient trained human resources, (3) inadequate logistics, supplies and medications, (4) lack of laboratory facilities, (5) inefficient referral mechanisms and (6) unavailability of systematic recording and reporting systems. These findings corroborate well to the ones reported in another recent study from Nepal 41 as well as other neighbouring countries. 43–45 Studies in Nepal have reported that despite implementation of the WHO PEN package, government’s role has been very limited to providing NCD-related services to combat the growing burden of NCDs in Nepal.…”

“…Results from our study are in concordance with the findings from other settings, where CHWs expressed the need of capacity building for the prevention and control of NCDs. 41 42 These findings are plausible because in past decades, the CHWs were very much capacitated on maternal and child health activities and were mostly dealing with communicable diseases. However, there had been a shortfall of skilled CHWs and accessibility to health services for combating the growing demands for NCDs services at the peripheral level health facilities.…”

“…Adding to this, while the government of Nepal is grappling with the financial challenges for implementing NCD programmes, using codesign approach for designing a model of care could be another avenue to plan, implement and sustain NCD-related programmes effectively in the country. 41 …”

“…Adding to this, while the government of Nepal is grappling with the financial challenges for implementing NCD programmes, using codesign approach for designing a model of care could be another avenue to plan, implement and sustain NCD-related programmes effectively in the country. 41 Limitations One of the key limitations of this study was, due to the resources limitations, we were unable to include beyond four districts of Nepal. Also, we did not gather data from the policymakers beyond the Health Ministry and the Department of Health Services at central level.…”

Evaluating the feasibility and acceptability of a co-design approach to developing an integrated model of care for people with multi-morbid COPD in rural Nepal: a qualitative study

“… 10 In response to this need, we conducted a study among people with COPD between 2018 and 2019 and identified low levels of health literacy, poor self-management practices and various barriers to self-management at patient-family, community and service provider levels. 9 11 12 These findings established the need to engage multiple stakeholders in service design to address the self-management needs of multi-morbid COPD people in Nepal.…”