Enhancing Confidence and Coping with Stigma in an Ambiguous Interaction with Primary Care: A Qualitative Study of People with COPD

Abstract

Meaningful and high-quality interactions between people with COPD and healthcare professionals are essential to accomplish effective and efficient self-management. This study's aim was to explore how people with COPD experience COPD-related interactions with healthcare professionals in primary care, and how these interactions influence their self-management and how they cope with their disease. Interviews were performed with eight women and five men with COPD, and grounded theory guided data collection and analysis. The analysis resulted in a theoretical model and the core category (Re)acting in an ambiguous interaction, representing a dynamic process in which healthcare priorities, healthcare professionals' attitudes and participants' personal emotions were important for the participants' experiences of interactions, and how they managed and coped with their disease. Mutually respectful and regular relationships with healthcare professionals, along with a personal positive view of life, empowered and facilitated participants to accept and manage their disease. In contrast, experiences of being deprioritized and not taken seriously, along with experiences of fear and stigma, disempowered and inhibited participants in making healthcare contacts or forced them to compensate for experienced insufficiencies in primary care. In order to facilitate meaningful and high-quality interactions and enhance patient-provider partnerships in primary care, there is a need to improve the status of COPD, as well as to increase competence in COPD management among healthcare professionals and support the empowerment of people with COPD. Findings from this study could guide the implementation of improved self-management support in primary care for COPD and other chronic conditions.

Stigma Experiences in People with Chronic Obstructive Pulmonary Disease: An Integrative Review

“… 36 , 41 In addition, people with COPD who continue smoking have feelings of being a failure or a loser. 34 , 36 , 41 , 42 …”

“…Shame and guilt related to the diagnosis and the idea of a chronic disease interfered with the acceptance of being diagnosed with COPD. 80.0% Lundell, Wadell, Wiklund and Tistad, 42 2020, Sweden To explore how people with COPD experience COPD-related interactions with healthcare professionals in primary care and how it influences their self-management Qualitative study using grounded theory People with COPD (n = 13) Age (mean) = 69 yrs (range 48–80 yrs) Smoking status: former (n = 7); current (n = 6) Positive view of life and mutually respectful relationship of people with COPD with healthcare professionals empowered and facilitated acceptance and management of their COPD. Experiences of being deprioritized, fear, and stigma disempowered and inhibited people with COPD from seeking appropriate medical help as well as made them pass up a chance to get sufficient support from their healthcare professionals.…”

“…Of the included studies (n = 15), 14 used a qualitative research design [30][31][32][33][34][35][36][37][38][39][40][41][42][43] and one a mixed-method research design. 28 Ten studies collected data using individual interviewing, one used focus group interviewing, 40 three used both individual and focus group interviewing, 32,39,43 and one used individual interviewing along with a selfadministered questionnaire.…”

“…28 Ten studies collected data using individual interviewing, one used focus group interviewing, 40 three used both individual and focus group interviewing, 32,39,43 and one used individual interviewing along with a selfadministered questionnaire. 28 The methodological quality of the qualitative studies (n = 14) [30][31][32][33][34][35][36][37][38][39][40][41][42][43] ranged from 67% to 90% and the mixed-method study 28 scored 70% for the qualitative phase and 95% for the quantitative phase. 26 Four studies were conducted in the United Kingdom, 35,37,40,43 three in Sweden, 30,41,42 two in the United States, 31,33 two in Iceland, 32,38 one in Canada, 28 one in Korea, 39 one in Norway, 36 and one in Switzerland.…”

“…28 The methodological quality of the qualitative studies (n = 14) [30][31][32][33][34][35][36][37][38][39][40][41][42][43] ranged from 67% to 90% and the mixed-method study 28 scored 70% for the qualitative phase and 95% for the quantitative phase. 26 Four studies were conducted in the United Kingdom, 35,37,40,43 three in Sweden, 30,41,42 two in the United States, 31,33 two in Iceland, 32,38 one in Canada, 28 one in Korea, 39 one in Norway, 36 and one in Switzerland. 34 Ten studies included both men and women; 28,31,32,[34][35][36][40][41][42][43] the other five focused on more restricted groups: women only, 38 men only, 39 those newly diagnosed, 30 people on long-term supplemental oxygen, 33 and people who refused a referral to a pulmonary rehabilitation program after exp...…”