TY - JOUR
T1 - Facilitators and Barriers of Adherence to Multi-Disease Exacerbation Action Plans in COPD Patients - A Qualitative Study
AU - Schrijver, J.
AU - Effing, T.
AU - Brusse-Keizer, M.
AU - van der Palen, J.
AU - van der Valk, P.
AU - Lenferink, A.
N1 - Funding Information: This study was supported by the Stichting Astma Bestrijding, Lung Foundation Netherlands (grant number 3.4.11.061), Lung Foundation Australia (Australian Lung Foundation Boehringer Ingelheim COPD Research Fellowship), and Repat Foundation, GlaxoSmithKline (unrestricted grant). We thank all patients who participated in the interviews for sharing their time and experiences toward the COPE-III study participation. Furthermore, we thank Nina van Gameren (research assistant), Paul Cafarella (health psychologist), Suzanne Hoftijzer (student Master of Health Psychology and Technology at the University of Twente), and Annemarie Braakman-Jansen (researcher and assistant professor Psychology, Health and Technology at the University of Twente) for their valuable contribution to this study. Publisher Copyright: © 2023 The Author(s). Published with license by Taylor & Francis Group, LLC.
PY - 2023/12/1
Y1 - 2023/12/1
N2 - Whereas exacerbation action plans to self-manage Chronic Obstructive Pulmonary Disease (COPD) significantly improve health outcomes, patients' adherence to those action plans is often poor. This study aimed to identify facilitators and barriers of adherence to tailored multi-disease exacerbation action plans. We also explored patients' perspectives toward disease management roles. Individual semi-structured interviews were conducted with a sample of COPD patients who completed a Dutch-Australian self-management intervention evaluating tailored exacerbation action plans for COPD and relevant comorbidities. Interviews were thematically analyzed using a deductive approach guided by the Capability, Opportunity and Motivation of Behavior (COM-B) model. In 2016, ten patients (5 Australian; 5 Dutch; 6 men; age 59-83 years) were interviewed at the end of their one-year follow-up. Facilitators of adherence included improved patients' comprehension of disease and treatment, positive feelings about the intervention, improved self-confidence, and professional support. Barriers included difficulties to recognize symptoms, dislike toward daily symptom monitoring, negative feelings about the intervention, negative mood state, and complexity of symptom diaries and action plans. Patients indicated three distinctive perspectives of their own and their healthcare professional's role in their disease management: 1) patients felt mainly responsible; 2) patients felt shared responsibility with their healthcare professional; and 3) patients felt not responsible as they perceived their healthcare professional to be mainly responsible. We successfully used the COM-B model as a guide to identify facilitators and barriers of patients' adherence to multi-disease exacerbation action plans. Improving patients' adherence in future self-management interventions by targeting specific facilitators or barriers should be considered.
AB - Whereas exacerbation action plans to self-manage Chronic Obstructive Pulmonary Disease (COPD) significantly improve health outcomes, patients' adherence to those action plans is often poor. This study aimed to identify facilitators and barriers of adherence to tailored multi-disease exacerbation action plans. We also explored patients' perspectives toward disease management roles. Individual semi-structured interviews were conducted with a sample of COPD patients who completed a Dutch-Australian self-management intervention evaluating tailored exacerbation action plans for COPD and relevant comorbidities. Interviews were thematically analyzed using a deductive approach guided by the Capability, Opportunity and Motivation of Behavior (COM-B) model. In 2016, ten patients (5 Australian; 5 Dutch; 6 men; age 59-83 years) were interviewed at the end of their one-year follow-up. Facilitators of adherence included improved patients' comprehension of disease and treatment, positive feelings about the intervention, improved self-confidence, and professional support. Barriers included difficulties to recognize symptoms, dislike toward daily symptom monitoring, negative feelings about the intervention, negative mood state, and complexity of symptom diaries and action plans. Patients indicated three distinctive perspectives of their own and their healthcare professional's role in their disease management: 1) patients felt mainly responsible; 2) patients felt shared responsibility with their healthcare professional; and 3) patients felt not responsible as they perceived their healthcare professional to be mainly responsible. We successfully used the COM-B model as a guide to identify facilitators and barriers of patients' adherence to multi-disease exacerbation action plans. Improving patients' adherence in future self-management interventions by targeting specific facilitators or barriers should be considered.
KW - Chronic Obstructive Pulmonary Disease
KW - adherence
KW - disease management
KW - exacerbations
KW - qualitative research
KW - self-treatment
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85165918002&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/37503723
U2 - https://doi.org/10.1080/15412555.2023.2240408
DO - https://doi.org/10.1080/15412555.2023.2240408
M3 - Article
C2 - 37503723
SN - 1541-2563
VL - 20
SP - 262
EP - 273
JO - COPD
JF - COPD
IS - 1
ER -