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A health coaching self-management programme for patients with Chronic Obstructive Pulmonary Disease: An explorative and interventional study
Jönköping University, School of Health and Welfare, HHJ. ADULT.
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Chronic Obstructive Pulmonary Disease (COPD) is a primary cause of chronic morbidity and mortality and contributes to an increased economic and social burden on patients and families. Self-management education as one non-pharmacological treatment approach is highlighted in guidelines. Although self-management programmes have shown positive effects for COPD, lack of disease-specific self-management skills, high dropout rates, and poor attendance of participants are problems which should be taken under consideration. One way to cope with the problems is to use amore motivational approach which focuses on patients’ health decisions in cooperation with healthcare practitioners, combined with systematic and structured health coaching. However, there is a lack of such studies, which are needed to explore the effects of self-management on patients with COPD by health coaching, not least in China.

Aims: The overall aim of this thesis was to explore sociodemographic and clinical factors influencing self-management and to test and evaluate a health coaching self-management programme for patients with COPD in China.

Methods: The study’s design was explorative, prospective, and longitudinal, with both quantitative and qualitative approaches. Specifically, a quantitative method with a cross-sectional approach was used to explore the self-management status of patients with COPD and examine the associations with socio-demographic and clinical variables (I). Furthermore, a prospective randomized controlled trial was conducted to study the longitudinal effects of the health coaching self-management programme using a repeated-measures analysis of variance model of patients with COPD (II & III). A qualitative study implementing inductive content analysis was used to describe and explore participants’ experiences of the health coaching self-management programme of patients with COPD (IV).

Results: High physical activity, high salary, and low age affected the self-management of patients with COPD most positively (I). The health coaching programme improved lung function, physical activity, quality of life, and self-management skills, as well as psychological status in both the short and long term (II & III). Participants expressed their experiences of the health coaching self-management programme as making them more aware of the importance of knowledge of the disease and their own responsibilities, taking action to maintain a healthy lifestyle, feeling supported by the programme, and being hindered by individual and programme limitations (IV).

Conclusions: This thesis contributes to knowledge about the self-management skills of patients with COPD, which is low in China. A health coaching self-management programme with iterative interactions between patients and healthcare professionals represented a valuable and effective intervention designed to improve health-related outcomes. Moreover, low literacy, poor physical condition, and family and economic burdens should be taken into account in the development of future self-management programmes in China.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare , 2018. , p. 80
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 092
Keywords [en]
Chronic Obstructive Pulmonary Disease, Self-management, Health coaching
National Category
Nursing
Identifiers
URN: urn:nbn:se:hj:diva-41179ISBN: 978-91-85835-91-1 (print)OAI: oai:DiVA.org:hj-41179DiVA, id: diva2:1240092
Public defence
2018-09-13, Forum Humanum, School of Health and Welfare, Jönköping, 13:00 (English)
Opponent
Supervisors
Available from: 2018-08-20 Created: 2018-08-20 Last updated: 2018-08-20Bibliographically approved
List of papers
1. Self-management among patients with chronic obstructive pulmonary disease in China and its association with sociodemographic and clinical variables
Open this publication in new window or tab >>Self-management among patients with chronic obstructive pulmonary disease in China and its association with sociodemographic and clinical variables
2016 (English)In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 32, p. 61-66Article in journal (Refereed) Published
Abstract [en]

PURPOSE: This study aimed to examine the status of self-management in patients with COPD and its associations with sociodemographic and clinical variables.

METHODS: This cross-sectional study included 154 patients with COPD (mean age, 73 years) at four hospitals in Tianjin, China. The COPD Self-Management Scale was used to describe the level of self-management, and its associations with sociodemographic and clinical variables were examined with multiple regression analysis.

RESULTS: More than half of the patients with COPD had a low (30%) or moderate (27%) level of self-management. Self-management was rated highest in management of daily life and lowest in information management. Higher physical activity, higher salary, and lower age affected self-management the most positively.

CONCLUSION: The overall burden of COPD in China is greater than that found in other countries. Healthcare professionals need to improve their understanding of the importance of self-management and specifically focus on increased physical activity targeting patients with poor literacy skills.

Keywords
Self-management; Chronic obstructive pulmonary disease; Sociodemographic variables; Clinical variables
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-34600 (URN)10.1016/j.apnr.2016.05.001 (DOI)000388057100012 ()27969053 (PubMedID)2-s2.0-84969786258 (Scopus ID)HHJIMPROVEIS, HHJADULTIS (Local ID)HHJIMPROVEIS, HHJADULTIS (Archive number)HHJIMPROVEIS, HHJADULTIS (OAI)
Available from: 2017-01-02 Created: 2017-01-02 Last updated: 2018-08-20Bibliographically approved
2. A health coaching self-management programme to improve physical activity, lung function and quality of life in patients with Chronic Obstructive Pulmonary Disease: a randomized controlled trial
Open this publication in new window or tab >>A health coaching self-management programme to improve physical activity, lung function and quality of life in patients with Chronic Obstructive Pulmonary Disease: a randomized controlled trial
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Chronic obstructive pulmonary disease (COPD) is the fourth most prevalent cause of death in the world and contributes to higher economic and social burden. Health coaching, which is an approach to support self-management, has proven to be effective in health outcomes for patients with COPD in developed countries. However, no study has evaluated a systematic and structured health-coaching COPD programme to support self-management in China.

Objectives: To evaluate the effects of a health coaching self-management programme on lung function, physical activity and quality of life in patients with COPD

Design: A randomised controlled trial in patients with COPD

Methods: The participants were randomised to either an intervention group (n = 48) or a control group (n = 49) during hospitalisation. The intervention group received usual care combined with a health coaching self-management programme; the control group received only usual care. The intervention programme was performed for six months, and the effects of the intervention were assessed for FEV1%, FVC%, hand grip strength and 1-minute sit-to-stand (STS); and by the Global Physical Activity Questionnaire (GPAQ), Clinical COPD Questionnaire (CCQ) at baseline, 6th week, 6th month and 12th month follow-ups post-discharge.

Results: Of the 97 patients, 88% completed the 12-month follow-up (94% in the intervention group and 82% in the control group). The interaction effect between time and group (control or intervention) for lung function, physical activity and quality of life showed that the intervention group improved significantly compared to the control group in all measures: FEV1% (P =0.003), FVC% (P = 0.001), GPAQ (P = 0.001), 1-minute STS (P = 0.005) and Grip strength (P<0.001), as well as the CCQ-symptom (P <0.001), CCQ-emotion (P <0.001), CCQ-activity (P<0.001) and CCQ (P <0.001).

Conclusion: The health coaching self-management programme can improve lung function, physical activity and quality of life in patients with COPD.

Keywords
Chronic obstructive pulmonary disease, Health coaching, lung function, physical activity, quality of life, self-management
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-41177 (URN)
Note

Submitted to journal.

Available from: 2018-08-20 Created: 2018-08-20 Last updated: 2018-08-20
3. Effects of a health coaching self-management programme in patients with Chronic Obstructive Pulmonary Disease on self-management skills and psychological status: a randomized controlled trial
Open this publication in new window or tab >>Effects of a health coaching self-management programme in patients with Chronic Obstructive Pulmonary Disease on self-management skills and psychological status: a randomized controlled trial
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objectives: To evaluate the effects of a health coaching self-management programme intended to improve self-management skills and psychological status for patients with Chronic Obstructive Pulmonary Disease.

Design: Randomized controlled trial.

Methods: A randomized controlled study was conducted among patients with COPD. The participants who met the inclusion criteria were randomized to either an intervention group (n=48) or a control group (n=49). The intervention group received the health coaching self-management programme, while the control group received usual care. The programme were performed during six months, and the effects of the intervention were assessed by the COPD Self-management Scale (CSMS) and Hospital anxiety and depression scale (HADS) at baseline, 6th week, 6th month and 12th month post discharge.

Results: Of the 97 patients, 45 (94%) in the intervention group and 40 (82%) in control group, completed 12-month follow-up. The interaction effect between time and group (control or intervention) showed that the intervention group improved significantly compared to the control group for all five dimensions in self management skills, Symptom management (P<0.001), Daily life management (P<0.001), Emotion management (P<0.001), Information management (P<0.001) and Self-efficacy (P<0.001), as well as psychological status with anxiety (P<0.001) and depression (P<0.001).

Conclusion: This trial shows that a nurse-led Health Coaching Self-management Programme has the potential to significantly improve the effects on the self management skills, as well as reducing anxiety and depression for patients with COPD.

Keywords
Health Coaching, Self-management, Chronic Obstructive Pulmonary Disease, Anxiety, Depression
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-41178 (URN)
Note

Submitted to journal.

Available from: 2018-08-20 Created: 2018-08-20 Last updated: 2018-08-20
4. Experiences of a health coaching self-management program in patients with COPD: a qualitative content analysis.
Open this publication in new window or tab >>Experiences of a health coaching self-management program in patients with COPD: a qualitative content analysis.
2018 (English)In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 13, p. 1527-1536Article in journal (Refereed) Published
Abstract [en]

Purpose: To describe the experiences of patients with COPD participating in a health coaching self-management program.

Patients and methods: Twenty patients who had participated in a 6-month health coaching self-management program intervention were purposefully selected for a qualitative evaluation of the program using semi-structured interviews. The interviews were analyzed using inductive qualitative content analysis.

Results: Four categories and 13 subcategories emerged describing the participants' experiences of the program. Their experiences were expressed as gaining insight into the importance of knowledge and personal responsibilities in the management of COPD, taking action to maintain a healthy lifestyle, feeling supported by the program, and being hindered by individual and program limitations.

Conclusion: Iterative interactions between patients and health care professionals together with the content of the program are described as important to develop skills to manage COPD. However, in future self-management programs more awareness of individual prerequisites should be considered.

Place, publisher, year, edition, pages
Dove Medical Press, 2018
Keywords
chronic obstructive pulmonary disease, health coaching, qualitative content analysis, self-management
National Category
Respiratory Medicine and Allergy Nursing
Identifiers
urn:nbn:se:hj:diva-41081 (URN)10.2147/COPD.S161410 (DOI)00043204820000 ()29785102 (PubMedID)2-s2.0-85047080588 (Scopus ID)HHJADULTIS, HHJIMPROVEIS (Local ID)HHJADULTIS, HHJIMPROVEIS (Archive number)HHJADULTIS, HHJIMPROVEIS (OAI)
Available from: 2018-07-31 Created: 2018-07-31 Last updated: 2018-08-20Bibliographically approved

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