‘How do COPD patients perceive self-management of their illness and what can physiotherapists do to facilitate this? – a qualitative research.‘

Abstract

Background : In line with European public health policies, patients with Chronic Obstructive Pulmonary Disease (COPD) are being held more responsible for taking control of one's own health. However, studies have shown that the COPD population show less proactiveness and take less control in healthcare. The perception of COPD patients on self-management after newly introduced reimbursements policy have not yet been investigated. Aim: To discover what the perception of COPD patients on self-management is and what physiotherapists can do to facilitate this. Methods: Purposeful sampling of COPD patients and physiotherapists from physiotherapy centre ‘Van Kasteel’ was used. Four focus group interviews using an interview guide were conducted. Three of those were with patients and one with physiotherapists. Sessions were tape-recorded and transcribed verbatim. A constant comparison analysis strategy was used to analyse the data using ATLAS.ti. Results: Patients do not seem to be able to change their behaviour and are therefore not likely to take initiative for self-management. Informed decision-making (IDM) is complicated by the fact that patients do not actively search for information, despite the fact that they seem to have a need for information. Patients are also scoring low on shared decision-making (SDM). Only a few of them make decisions together with healthcare providers. In the field of behavioural change, there is a difference between what patients deem important and what physiotherapists think is necessary to improve their quality of life. Moreover, a discrepancy exists in the perception of physiotherapists. Whereas physiotherapists see themselves as facilitators in the treatment of COPD, patients consider physiotherapists as stimulators at most. Conclusion and key findings: Self-management does not seem to play a role in the life of the COPD patient. To improve patients IDM, SDM and behavioural change, physiotherapists should use an integrated approach according to the knowledge and theory of behavioural change models and focus more on communication and adequate provision of information to improve self-management in COPD patients. The results of this study could help define a new strategy on how to incentivize the desired behaviour among COPD patients to improve self-management.