Assessing the effect of culturally specific audiovisual educational interventions on attaining self-management skills for chronic obstructive pulmonary disease in Mandarin- and Cantonese-speaking patients: a randomized controlled trial

Abstract

BackgroundPatient education is a key component in the management of chronic obstructive pulmonary disease (COPD). Delivering effective education to ethnic groups with COPD is a challenge. The objective of this study was to develop and assess the effectiveness of culturally and linguistically specific audiovisual educational materials in supporting self-management practices in Mandarin- and Cantonese-speaking patients.MethodsEducational materials were developed using participatory approach (patients involved in the development and pilot test of educational materials), followed by a randomized controlled trial that assigned 91 patients to three intervention groups with audiovisual educational interventions and one control group (pamphlet). The patients were recruited from outpatient clinics. The primary outcomes were improved inhaler technique and perceived self-efficacy to manage COPD. The secondary outcome was improved patient understanding of pulmonary rehabilitation procedures.ResultsSubjects in all three intervention groups, compared with control subjects, demonstrated postintervention improvements in inhaler technique (P<0.001), preparedness to manage a COPD exacerbation (P<0.01), ability to achieve goals in managing COPD (P<0.01), and understanding pulmonary rehabilitation procedures (P<0.05).ConclusionCulturally appropriate educational interventions designed specifically to meet the needs of Mandarin and Cantonese COPD patients are associated with significantly better understanding of self-management practices. Self-management education led to improved proper use of medications, ability to manage COPD exacerbations, and ability to achieve goals in managing COPD.Clinical implicationA relatively simple culturally appropriate disease management education intervention improved inhaler techniques and self-management practices. Further research is needed to assess the effectiveness of self-management education on behavioral change and patient empowerment strategies.

A Conceptual Model of Functional Health Literacy to Improve Chronic Airway Disease Outcomes

“…Other studies have concluded that empowering patients by improving their HL could enhance their self-con dence in controlling disease symptoms and managing their disease condition, which could improve health outcomes [35,[82][83][84][85][86][87][88]. To empower an individual to have greater control over their own health, they must be con dent in their ability to take control of their disease management (e.g., self-e cacy) and have the necessary skills (e.g., empowerment) to do so while navigating the complexities of the healthcare system [50].…”

“…To empower an individual to have greater control over their own health, they must be con dent in their ability to take control of their disease management (e.g., self-e cacy) and have the necessary skills (e.g., empowerment) to do so while navigating the complexities of the healthcare system [50]. As evidenced by the literature, an empowered individual is more likely to comprehend their health issues and understand health instructions, seek proper care services, navigate successfully through the health care system, evaluate the usefulness of health information received, describe symptoms and triggers, and make informed decisions by applying the gained information and experiences to maintain their health [83][84][85][86][87]. Therefore, if the goal of improved HL is to empower an individual to properly manage their health condition, all the necessary factors that play crucial roles in this process should be identi ed and applied in the development of a HL intervention model to improve disease self-management.…”

A conceptual model of functional health literacy to improve chronic airway disease outcomes

“…Finally, we conceptualized HL in a way to explain a structurally health literate competent care system, "a system that adopts HL as an organizational value strategy in its care model" [39,89]. Such a care system should not only provide equal opportunity to all community members in accessing the needed health information and services, but also empower patients with the skills necessary to navigate the system and obtain the care they need to manage their condition [41,66]. Health care providers should consider the role that they play in their patients' HL, and how their behaviours across the core HL domains (e.g.…”

“…A Validity-Driven approach [65] was used in the development of the CADMaHL conceptual model. Firstly, the Chronic Care Model (CCM) [66] was used for integration of key-informants and knowledge users on the research team (patients, health care professionals, and health care decision-makers) to incorporate their guidance on topics and items selection. Secondly, the Interactive Systems Framework (ISF) [67] served as the foundation for integrating of patients' and key-informants' understanding of potential factors that in uence HL into our model-speci cally related to disease self-management practices.…”

Translation, cross-cultural adaptation, and reliability of the Understanding COPD questionnaire for use in Brazil

“…This might be due to a lack of understanding of the importance of appropriate behavior or to a lack of disease-related self-efficacy. Educational interventions can change these outcomes and have proved to be effective in patients with COPD, being associated with improvement in self-management skills, 2 i.e., improved medication use, increased ability to manage disease exacerbations, and increased ability to achieve disease management goals 5 . However, despite its importance, education is seldom evaluated in PRPs because there are only a few instruments available for this purpose.…”