Assessing the effect of culturally specific audiovisual educational interventions on attaining self-management skills for chronic obstructive pulmonary disease in Mandarin- and Cantonese-speaking patients: a randomized controlled trial

International Journal of COPD Dovepress open access to scientific and medical research Original Research International Journal of Chronic Obstructive Pulmonary Disease downloaded from https://www.dovepress.com/ by 88.198.20.149 on 06-May-2021 For personal use only. Open Access Full Text Article Assessing the effect of culturally specific audiovisual educational interventions on attaining self-management skills for chronic obstructive pulmonary disease in Mandarin- and Cantonesespeaking patients: a randomized controlled trial This article was published in the following Dove Press journal: International Journal of COPD 3 August 2016 Number of times this article has been viewed Iraj Poureslami, 1,2 Susan Kwan, 3 Stephen Lam, 4,5 Nadia A Khan, 6,7 John Mark FitzGerald 8,9 Respiratory Division, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada; 2Department of Graduate Studies, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada; 3Respiratory Department, Burnaby Hospital, University of British Columbia, Burnaby, Canada; 4 Respiratory Division, University of British Columbia, Vancouver, Canada; 5Department of Integrative Oncology, BC Cancer Research Centre, Vancouver, Canada; 6 Department of Internal Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada; 7 Department of Internal Medicine, Providence Health Care Authority, Vancouver, Canada; 8VGH Divisions of Respiratory Medicine, University of British Columbia, Vancouver, Canada; 9 Respiratory Medicine, Vancouver Coastal Health Authority, Vancouver Coastal Health Research Institute, Institute for Heart and Lung Health, The Lung Centre, Gordon and Leslie Diamond Health Care Centre, Vancouver, Canada 1 Correspondence: John Mark FitzGerald The Lung Centre, Gordon and Leslie Diamond Health Care Centre, 7th floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada Email Introduction Chronic obstructive pulmonary disease (COPD) continues to be an important cause of morbidity and mortality and a driver of health care costs worldwide.1–5 It is estimated 1811 submit your manuscript | www.dovepress.com International Journal of COPD 2016:11 1811–1822 Dovepress © 2016 Poureslami et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/COPD.S105408 Powered by TCPDF (www.tcpdf.org) Background: Patient education is a key component in the management of chronic obstructive pulmonary disease (COPD). Delivering effective education to ethnic groups with COPD is a challenge. The objective of this study was to develop and assess the effectiveness of culturally and linguistically specific audiovisual educational materials in supporting self-management practices in Mandarin- and Cantonese-speaking patients. Methods: Educational materials were developed using participatory approach (patients involved in the development and pilot test of educational materials), followed by a randomized controlled trial that assigned 91 patients to three intervention groups with audiovisual educational interventions and one control group (pamphlet). The patients were recruited from outpatient clinics. The primary outcomes were improved inhaler technique and perceived self-efficacy to manage COPD. The secondary outcome was improved patient understanding of pulmonary rehabilitation procedures. Results: Subjects in all three intervention groups, compared with control subjects, demonstrated postintervention improvements in inhaler technique (P,0.001), preparedness to manage a COPD exacerbation (P,0.01), ability to achieve goals in managing COPD (P,0.01), and understanding pulmonary rehabilitation procedures (P,0.05). Conclusion: Culturally appropriate educational interventions designed specifically to meet the needs of Mandarin and Cantonese COPD patients are associated with significantly better understanding of self-management practices. Self-management education led to improved proper use of medications, ability to manage COPD exacerbations, and ability to achieve goals in managing COPD. Clinical implication: A relatively simple culturally appropriate disease management education intervention improved inhaler techniques and self-management practices. Further research is needed to assess the effectiveness of self-management education on behavioral change and patient empowerment strategies. Keywords: COPD, educational material, cultural background, self-efficacy, self-management, Chinese community Dovepress International Journal of Chronic Obstructive Pulmonary Disease downloaded from https://www.dovepress.com/ by 88.198.20.149 on 06-May-2021 For personal use only. Poureslami et al that by 2020, COPD will be the third leading cause of death worldwide.6–8 Successful long-term management of COPD requires active patient involvement in self-management practice.7 Achieving success in self-management has been associated with an increased sense of patient self-efficacy9–11 and high levels of patient confidence in their ability to understand and follow providers’ instructions and recommended action plans.12,13 Despite the importance of teaching patients how to manage their disease, there is inconclusive evidence regarding the effectiveness of educational interventions in supporting skill attainment. Studies have found improvements in COPD self-management using case-managed educational interventions.14–16 Other studies have shown that patient education may increase disease-related knowledge, but does not always ensure that patients gain the necessary self-management skills.17,18 This lack of effect may, in some instances, be a function of patients’ failure to fully master self-management.9,10,19,20 Multiple factors affect patients’ ability to learn and adhere to care plans, including patients’ perception of their disease, type of treatment or medication, quality of patient–provider communication, and impediments to comprehension and uptake posed by language and cultural barriers.5,7,8,21 The mixed results in the literature make it clear there is more to learn about designing and implementing educational interventions to effectively empower patients to self-manage COPD. Research has shown that people learn better when provided with audiovisual materials compared to print handouts.14–16 Our previous research indicates a practical way to reach (...truncated)