Qualitative systematic review of barriers and facilitators to self-management of chronic obstructive pulmonary disease: views of patients and healthcare professionals

Abstract

Self-management interventions for chronic obstructive pulmonary disease (COPD) can improve quality of life, reduce hospital admissions, and improve symptoms. However, many factors impede engagement for patients and practitioners. Qualitative research, with its focus on subjective experience, can provide invaluable insights into such factors. Therefore, a systematic review and synthesis of qualitative evidence on COPD self-management from the perspective of patients, carers, and practitioners was conducted. Following a systematic search and screening, 31 studies were appraised and data extracted for analysis. This review found that patients can adapt to COPD; however, learning to self-manage is often a protracted process. Emotional needs are considerable; frustration, depression, and anxiety are common. In addition, patients can face an assortment of losses and limitations on their lifestyle and social interaction. Over time, COPD can consume their existence, reducing motivation. Support from family can prove vital, yet tinged with ambivalence and burden. Practitioners may not have sufficient time, resources, or appropriate skills or confidence to provide effective self-management support, particularly in regard to patients’ psychosocial needs. This can compound patients’ capability to engage in self-management. For COPD self-management to be effective, patients’ psychosocial needs must be prioritised alongside medication and exacerbation management. In addition, patients’ personal beliefs regarding COPD and its management should be reviewed periodically to avoid problematic behaviours and enhance positive adaptions to the disease. Patients with COPD are not a homogenous group and no one intervention will prove effective for all. Finally, practitioners require greater education, training, and support to successfully assist patients.

<p>Development and Pretesting of a New Functional-Based Health Literacy Measurement Tool for Chronic Obstructive Pulmonary Disease (COPD) and Asthma Management</p>

“…28,29 We found the results of the needs assessment study were not only useful for guiding the development of our proposed HL tool but also helped to identify possible gaps in respiratory disease management research. Our participants reported several barriers for engaging in selfmanagement practices, which are consistent with those found in the literature; [40][41][42][43] including improper communication with health-care providers and difficulty accessing and understanding health-related information. Utilizing medical jargon and unfamiliar terminology (in verbal or written communication) by health-care providers, in "I don't know that I would talk about diet, and mentioned exercise but not in specifics about I want to do this, so can we come up with a plan for me to be able to stabilize me being active?"…”

“…-Asthma addition to patients' failure to communicate their questions or concerns, were inevitably reported by different studies as major obstacles to appropriate engagement in diseasemanagement process. 41,42,[44][45][46] Around 70% of patients in our study indicated they knew their limitations such as lack of transportation, lack of speaking the same language that the physician, lack of education in their disease, etc., however, many of them also stated they felt reluctant to express their concerns or ask questions, due to the short visit time or attitude of the care provider. In addition, more than half of our study participants reported having low confidence in their health-care provider's interest to listen or respond their questions, preventing proper communication with their care provider.…”

Prevalence of disability among adults with chronic obstructive pulmonary disease, Behavioral Risk Factor Surveillance System 2016–2017

“…[1] Symptoms pertaining to COPD, including chronic bronchitis and emphysema, are typically breathlessness, chronic airway obstruction, and chronic cough. [3] While smoking is the most common risk factor for COPD, exposure to air pollution, repeated respiratory infections, occupational exposure and genetic risk have also been found to be associated with COPD. [1,2,4] There are gender differences in the prevalence of COPD nationally among adults of all ages, as a higher prevalence has been reported among women compared to men, 7.0% vs 4.3% respectively.…”

Barriers to and competency with the use of metered dose inhaler and its impact on disease control among adult asthmatic patients in Ethiopia

“…The questionnaire contains 25 barrier questions in five different domains [20,21]. Socio demographic and clinical data of patients were incorporated in our questionnaire.…”