University of Twente Student Theses


Facilitators and barriers of adherence to multi-morbid exacerbation action plans in COPD patients with comorbidities : a qualitative study

Hoftijzer, S. (2020) Facilitators and barriers of adherence to multi-morbid exacerbation action plans in COPD patients with comorbidities : a qualitative study.

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Abstract:Background: Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease, of which the majority of patients suffers from at least one comorbidity. Whereas the use of exacerbation action plans to self-manage COPD patients’ condition significantly improves health outcomes, poor adherence is common. The presence of comorbidities, limited knowledge of symptoms and being passive towards disease management, decrease patients’ abilities and motivation to be adherent self-managers. Currently, it remains unknown what factors influence adherence to action plans that take into account common comorbidities. Objective: The aim of this study is to identify facilitators and barriers of adherence to multimorbid exacerbation action plans in COPD patients with ischaemic heart disease, chronic heart failure, diabetes mellitus, anxiety and/or depression. Methods: Qualitative research was performed using a subsample of Dutch and Australian patients who participated in a self-management trial (COPE-III). Individual semi-structured interviews were conducted on patients’ experiences with symptom diaries and exacerbation action plans in patients with moderate to severe COPD and ≥ 1 comorbidity. A deductivedominant content analysis approach was used to analyse the interview data, with the Capability, Opportunity, Motivation model of behaviour change as theoretical framework. Results: Ten patients (5 Australian, 5 Dutch, 6 males, age range 59-83) were interviewed. Patients’ perspectives on roles towards disease management encompassed patients feeling mainly responsible themselves, patients feeling just as responsible as they perceive the healthcare provider to be, and patients having no active role as they perceive the healthcare provider to be mainly responsible. Facilitators of adherence included the continuous availability of professional support, positive beliefs about the effectiveness of the symptom diary and action plan, and self-confidence in one’s abilities to use the action plan. Barriers of adherence included patients’ incapability of memorizing to use the symptom diary daily, insufficient comprehension of symptoms, the symptom diary’ complexity, aversion towards medication use, and a lack of stimulation to use the diary in stable phase. Conclusion: To optimize adherence, the number of contact hours with case managers should increase in which patients’ individual barriers can be addressed and strategies to overcome these barriers can be identified. The benefits of symptom diary use should be more emphasized and patients should be coached into taking on main responsibility for disease management and therefore improve patients’ motivation to be adherent. E-health should be introduced to suit individual preferences regarding the symptom diary’s ease of use to increase patients’ opportunity to be adherent.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:77 psychology
Programme:Psychology MSc (66604)
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