Determinants of activation for self-management in patients with COPD

Abstract

BackgroundCOPD self-management is a complex behavior influenced by many factors. Despite scientific evidence that better disease outcomes can be achieved by enhancing self-management, many COPD patients do not respond to self-management interventions. To move toward more effective self-management interventions, knowledge of characteristics associated with activation for self-management is needed. The purpose of this study was to identify key patient and disease characteristics of activation for self-management.MethodsAn explorative cross-sectional study was conducted in primary and secondary care in patients with COPD. Data were collected through questionnaires and chart reviews. The main outcome was activation for self-management, measured with the 13-item Patient Activation Measure (PAM). Independent variables were sociodemographic variables, self-reported health status, depression, anxiety, illness perception, social support, disease severity, and comorbidities.ResultsA total of 290 participants (age: 67.2±10.3; forced expiratory volume in 1 second predicted: 63.6±19.2) were eligible for analysis. While poor activation for self-management (PAM-1) was observed in 23% of the participants, only 15% was activated for self-management (PAM-4). Multiple linear regression analysis revealed six explanatory determinants of activation for self-management (P<0.2): anxiety (β: −0.35; −0.6 to −0.1), illness perception (β: −0.2; −0.3 to −0.1), body mass index (BMI) (β: −0.4; −0.7 to −0.2), age (β: −0.1; −0.3 to −0.01), Global Initiative for Chronic Obstructive Lung Disease stage (2 vs 1 β: −3.2; −5.8 to −0.5; 3 vs 1 β: −3.4; −7.1 to 0.3), and comorbidities (β: 0.8; −0.2 to 1.8), explaining 17% of the variance.ConclusionThis study showed that only a minority of COPD patients is activated for self-management. Although only a limited part of the variance could be explained, anxiety, illness perception, BMI, age, disease severity, and comorbidities were identified as key determinants of activation for self-management. This knowledge enables health care professionals to identify patients at risk of inadequate self-management, which is essential to move toward targeting and tailoring of self-management interventions. Future studies are needed to understand the complex causal mechanisms toward change in self-management.

Factors influencing exacerbation-related self-management in patients with COPD: a qualitative study

“…Previous studies have also observed differences between patients who pro-actively monitored the course of an exacerbation and contacted their HCP on time and patients who postponed health care contact until feeling an urgency for medical care 21,24,30,41. Finally, regarding smoking in relation to self-management, our study concurred with earlier studies in showing that smoking was not an explanatory factor for self-management behavior 42,43…”

Self-rated health aspects among persons living with chronic obstructive pulmonary disease

“…These results correspond to those of a study by Bos-Touwen et al, which identified physical health status and social support as associated with activation for self-management in a population living with chronic diseases (COPD, type 2 diabetes mellitus, chronic heart failure, and chronic renal disease) 18. However, in a later study of determinants of self-management in COPD patients only, illness perception and GOLD stage, but not social support, were identified as explanatory determinants 54. This difference in results illustrates the complexity of self-management of COPD.…”

Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates

“…Our qualitative feedback from our intervention teams highlighted the presence of multiple inhalers, often containing overlapping formulations in the homes of study subjects and an associated poor level of inhaler technique. COPD patients do not easily engage in self-management programs due to many factors,50 and because of these challenges, intensive longer follow-up than in our study is required. In addition, given the known cognitive impairment and reduced levels of health literacy in this patient population,51,52 it is not hard to imagine that an intensive and sustained humanomics-based intervention would be effective 53…”