Effects of a COPD self-management support intervention: a randomized controlled trial

International Journal of Chronic Obstructive Pulmonary Disease, Nov 2018

Effects of a COPD self-management support intervention: a randomized controlled trial Heidi B Bringsvor,1,2 Eva Langeland,3 Bjørg Frøysland Oftedal,2 Knut Skaug,1 Jörg Assmus,4 Signe Berit Bentsen5 1Department of Research and Innovation, Helse Fonna HF, Haugesund, Norway; 2Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; 3Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway; 4Center for Clinical Research, Department of Reserach and Innovation, Haukeland University Hospital, Bergen, Norway; 5SHARE-Centre for Resilience in Health Care, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway Background: This study examines the effects of the COPD-specific health promoting self-management intervention “Better living with COPD” on different self-management-related domains, self-efficacy, and sense of coherence (SOC). Methods: In a randomized controlled design, 182 people with COPD were allocated to either an intervention group (offered Better living with COPD in addition to usual care) or a control group (usual care). Self-management-related domains were measured by the Health Education Impact Questionnaire (heiQ) before and after intervention. Self-efficacy was measured by the General Self-Efficacy Scale (GSE) and SOC was measured by the 13-item Sense of Coherence Scale (SOC-13). Effects were assessed by ANCOVA, using intention-to-treat (ITT) analysis and per-protocol analysis (PPA). Results: The PPA and the ITT analysis showed significant positive changes on Constructive attitudes and approaches (heiQ) (ITT: P=0.0069; PPA: P=0.0021) and Skill and technique acquisition (heiQ) (ITT: P=0.0405; PPA: P=0.0356). Self-monitoring and insight (heiQ) showed significant positive change in the PPA (P=0.0494). No significant changes were found on the other self-management domains (heiQ), self-efficacy (GSE), or SOC (SOC-13). Conclusion: Better living with COPD had a significant positive short-term effect on some self-management-related domains, and could be an intervention contributing to the support of self-management in people with COPD. However, further work is needed to establish the clinical relevance of the findings and to evaluate the long-term effects. Keywords: constructive attitudes and approaches, Health Education Impact Questionnaire (heiQ), self-efficacy, self-monitoring and insight, sense of coherence, skill and technique acquisition

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Effects of a COPD self-management support intervention: a randomized controlled trial

Authors Bringsvor HB, Langeland E, Oftedal BF, Skaug K, Assmus J, Bentsen SB Received 21 July 2018 Accepted for publication 30 September 2018 Published 8 November 2018 Volume 2018:13 Pages 3677—3688 DOI https://doi.org/10.2147/COPD.S181005 Checked for plagiarism Yes Review by Single-blind Peer reviewers approved by Dr Cristina Weinberg Peer reviewer comments 2 Editor who approved publication: Dr Richard Russell Heidi B Bringsvor,1,2 Eva Langeland,3 Bjørg Frøysland Oftedal,2 Knut Skaug,1 Jörg Assmus,4 Signe Berit Bentsen5 1Department of Research and Innovation, Helse Fonna HF, Haugesund, Norway; 2Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; 3Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway; 4Center for Clinical Research, Department of Reserach and Innovation, Haukeland University Hospital, Bergen, Norway; 5SHARE-Centre for Resilience in Health Care, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway Background: This study examines the effects of the COPD-specific health promoting self-management intervention “Better living with COPD” on different self-management-related domains, self-efficacy, and sense of coherence (SOC). Methods: In a randomized controlled design, 182 people with COPD were allocated to either an intervention group (offered Better living with COPD in addition to usual care) or a control group (usual care). Self-management-related domains were measured by the Health Education Impact Questionnaire (heiQ) before and after intervention. Self-efficacy was measured by the General Self-Efficacy Scale (GSE) and SOC was measured by the 13-item Sense of Coherence Scale (SOC-13). Effects were assessed by ANCOVA, using intention-to-treat (ITT) analysis and per-protocol analysis (PPA). Results: The PPA and the ITT analysis showed significant positive changes on Constructive attitudes and approaches (heiQ) (ITT: P=0.0069; PPA: P=0.0021) and Skill and technique acquisition (heiQ) (ITT: P=0.0405; PPA: P=0.0356). Self-monitoring and insight (heiQ) showed significant positive change in the PPA (P=0.0494). No significant changes were found on the other self-management domains (heiQ), self-efficacy (GSE), or SOC (SOC-13). Conclusion: Better living with COPD had a significant positive short-term effect on some self-management-related domains, and could be an intervention contributing to the support of self-management in people with COPD. However, further work is needed to establish the clinical relevance of the findings and to evaluate the long-term effects. Keywords: constructive attitudes and approaches, Health Education Impact Questionnaire (heiQ), self-efficacy, self-monitoring and insight, sense of coherence, skill and technique acquisition Introduction COPD is characterized by persistent airflow limitation and respiratory symptoms, due to abnormalities in airways and/or the alveolus, and is a leading cause of mortality and morbidity worldwide.1,2 The disease is common, preventable, and treatable,2 and individuals living with COPD must make daily decisions regarding their own care; thus, self-management is an essential part of living with COPD3,4 and essential for the health care system’s efficiency and effectiveness.5 Still, previous studies suggest that individuals’ management of COPD is often far from optimal.6–8 Various self-management support interventions (SMIs) have been developed to facilitate adequate self-management of COPD.9,10 However, agreement on the definition of SMIs has previously been lacking,11 although their multifaceted nature and emphasis on enhancing people’s active roles and responsibilities have been highlighted.12 Recent guidelines state that SMIs for people with COPD are “structured but personalized and often multi-component interventions, with goals of motivating, engaging and supporting the participants to positively adapt their behavior(s) and develop skills to better manage their disease”.13,14 SMIs should provide information,12 elicit personalized goals, formulate appropriate strategies, and focus on intrinsic processes (eg, motivation, resource utilization, coping, and self-efficacy),11,13–15 and mental health.10 Furthermore, behavior change techniques are recommended to elicit participants’ motivation, confidence, and competence.14 Recent systematic reviews and meta-analyses of randomized controlled trials of COPD-specific multicomponent SMIs in primary care show positive effects of SMIs, such as a reduced number of unscheduled physician visits16 and COPD-related hospital admissions,9,12,17 reduced emotional distress,16,17 improved health-related quality of life (HRQoL),9 and increased self-efficacy.16 Two other systematic and integrative reviews18,19 reported less dyspnea,18 changed health care util (...truncated)


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Heidi B Bringsvor, Eva Langeland, Bjørg Frøysland Oftedal, Knut Skaug, Jörg Assmus, Signe Berit Bentsen. Effects of a COPD self-management support intervention: a randomized controlled trial, International Journal of Chronic Obstructive Pulmonary Disease, 2018, pp. 3677-3688, DOI: 10.2147/COPD.S181005