Patient and provider perspectives of a self-management program for COPD in the context of multimorbidity: a qualitative study

BMC Primary Care Ansari et al. BMC Primary Care (2025) 26:357 https://doi.org/10.1186/s12875-025-03077-5 Open Access RESEARCH Patient and provider perspectives of a selfmanagement program for COPD in the context of multimorbidity: a qualitative study Sameera Ansari1,2,3*, Hassan Hosseinzadeh4, Sarah Dennis5,6,7, Teresa Sheng1,8, Mohana Kunasekaran9, Sadan Taher8 and Nicholas Zwar1,3 Abstract Background Chronic obstructive pulmonary disease (COPD) is often associated with comorbidities, which further complicates the impact of the disease. However, most self-management support for COPD do not account for patients’ comorbidities. This study is the qualitative evaluation of a novel self-management program for people with COPD in the context of multimorbidity, delivered by practice nurses (PNs) in collaboration with general practitioners (GPs) in Sydney, Australia. Methods Semi-structured interviews were conducted with 12 patients, 10 PNs, and seven GPs. The interviews were thematically analysed using a constructivist approach, and further interpreted through the Normalisation Process Theory. Results Most patients accepted the program and perceived it as beneficial. Facilitators towards better activation were personalised care and the PNs’ counselling approach during the program. Barriers to better health behaviour included personal challenges and comorbidities. Overall, the PNs and GPs found the program to be feasible and beneficial for participating patients. The PNs felt upskilled about COPD, and confident for delivering self-management support, following participation in the study. The main challenge faced by them were managing their existing workload alongside the education sessions. Conclusions The findings emphasise the need for tailored, self-management support for people with COPD and comorbidities, and upskilling of the PN’s role in general practice. Keywords COPD, Self-management, Multimorbidity, Primary care, Patient activation, Implementation science *Correspondence: Sameera Ansari 1 School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Randwick, Sydney, NSW, Australia 2 Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia 3 Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia 4 School of Health and Society, University of Wollongong Australia, Wollongong, NSW, Australia 5 Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia 6 South Western Sydney Local Health District, Sydney, NSW, Australia 7 Ingham Institute for Applied Medical Research, Sydney, NSW, Australia 8 School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia 9 Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia © The Author(s) 2025. 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To view a copy of this licence, visit http://creati vecommons.org/licenses/by-nc-nd/4.0/. Ansari et al. BMC Primary Care (2025) 26:357 Background Chronic obstructive pulmonary disease (COPD) was the fourth leading cause of death globally in 2021 [1], and the fifth leading cause of death in Australia in 2023 [2]. COPD frequently occurs in the context of multimorbidity contributing to increased mortality, healthcare utilisation, and reduced quality of life [3, 4]. Furthermore, people with COPD and comorbidities often have difficulty recognising the importance of the disease and its implications [5]. Prior research has shown self-management support to improve quality of life and self-efficacy in people with COPD, highlighting the need for a biopsychosocial perspective to such interventions [6]. However, effective management of the disease by primary care providers has always been a challenge due to psychological barriers including stigma and fear of judgement [7]. Effective self-management is challenged by patientlevel factors including individual context, and COPD knowledge and understanding [8]. Self-management support for COPD are substantially heterogenous; there has been limited insight into the perspectives of patients receiving, and healthcare providers delivering, such programs, with a key feature of these interventions being nurse involvement [9]. In Australia, practice nurses (PNs) are increasingly contributing to chronic disease management and care coordination of patients with COPD in primary care, which could lead to significant uptake of pulmonary rehabilitation and other relevant healthcare services [10]. There is a lack of effective self-management support for COPD in primary care that specifically recognise the implications of comorbidities and patient’s motivation and skills in a psychosocial context. The authors (SA, HH, SD and NZ) developed, implemented and evaluated a global-first, PN-delivered, tailored, self-management program for COPD in the context of patients’ multimorbidity [11]. The complex program comprised multiple components including COPD knowledge; self-management strategies such as COPD Action Plan, referral to pulmonary rehabilitation, inhaler device technique, medication adherence and vaccination; strategies to cope with multimorbidity and smoking cessation. The PNs were trained to deliver the program in three one-to-one health coaching sessions followed by monthly follow-up calls for six months. The single-arm pilot trial, titled the Activating Primary Care COPD Patients with Multimorbidity (APCOM) study, was conducted in general practices across Sydney, Australia. The quantitative findings of the study can be found elsewhere; in brief, there were significant improvements in patient activation, COPD knowledge, COPD-related quality of life and accuracy of inhaler device technique at six months’ follow-up following the self-management program [12]. Page 2 of 14 This paper describes the qualitative evaluation of the APCOM Program through post-study interviews conducted with participating patients, PNs and general practitioners (GPs). The aim of these semi-structured interviews was to gain their (...truncated)