Supporting Behavior Change After AECOPD – Development of a Hospital-Initiated Intervention Using the Behavior Change Wheel

Abstract

After hospitalization due to acute COPD exacerbations, patient-manageable behaviors influence rehospitalization frequency. This study's aim was to develop a hospital-ward-initiated Behaviour-Change-Wheel (BCW)-based intervention targeting patients' key health behaviors, with the aim to increase quality of life and reduce rehospitalization frequency. Intervention development was performed by University Hospital Zurich working groups and followed the three BCW stages for each of the three key literature-identified problems: insufficient exacerbation management, lack of physical activity and ongoing smoking. In stage one, by analyzing published evidenceincluding but not limited to patients' perspective -and health professionals' perspectives regarding these problems, we identified six target behaviors. In stage two, we identified six corresponding intervention functions. As our policy category, we chose developing guidelines and service provision. For stage three, we defined eighteen basic intervention packages using 46 Behaviour Change Techniques in our basic intervention. The delivery modes will be face-to-face and telephone contact. In the inpatient setting, this behavioral intervention will be delivered by a multi-professional team. For at least 3 months following discharge, an advanced nursing practice team will continue and coordinate the necessary care package via telephone. The intervention is embedded in a broader self-management intervention complemented by integrated care components. The BCW is a promising foundation upon which to develop our COPD intervention. In future, the interaction between the therapeutic care team-patient relationships and the delivery of the behavioral intervention will also be evaluated.

Acceptability, Appropriateness and Feasibility of a Nurse-Led Integrated Care Intervention for Patients with Severe Exacerbation of COPD from the Healthcare Professional’s Perspective – A Mixed Method Study

“…It is common for co-morbidities such as psychiatric illnesses to complicate the standardized implementation of a self-management intervention that relies on stable physical and psychological capacities. 9 , 27 …”

“…Using the BCW as a methodological approach, 10 interventions concerning three key behaviors that influence COPD progression were developed: exacerbation management, physical activity, and ongoing smoking. 9 The final intervention includes six complementary behaviors: adherence to vaccination recommendations; adherence to inhalation; adherence to long-term oxygen; adherence to nutrition to prevent or manage underweight; management of dyspnea and related emotional distress; and writing an advance care plan for end-of-life-care. While the intervention is delivered by a range of different professionals (nurses, physicians, physiotherapists and, if needed, social workers, nutritionists, and psychiatrists) the overall lead has an advanced practice nurse (APN) team.…”

“…It is common for co-morbidities such as psychiatric illnesses to complicate the standardized implementation of a self-management intervention that relies on stable physical and psychological capacities. 9,27 The literature on outcomes in implementation research continues to develop and recent publications describe acceptability, appropriateness, and feasibility as possible predictors or determinants of implementation, classified as "antecedent assessments" rather than as direct implementation outcomes. 34,35 Our work is based on a different conceptualization, but can contribute to transparency in order to compare research results and to demonstrate the practical usefulness of existing instruments.…”

“…In Switzerland, quality of acute inpatient care for patients with severe acute exacerbations of COPD (AECOPD) is high, but researchers have identified a lack of coordinated self-management support across various sectors. 7 , 8 To address this gap in service delivery, Schmid-Mohler et al 9 developed the nurse-led integrated care COPD (NICCO) intervention. The development was guided by the Behaviour Change Wheel (BCW) framework.…”