Self-management behaviors in patients with chronic obstructive pulmonary disease: The role of physical limitation

Abstract

Background: Self-management has been used for decades as a means to tackle the challenges of chronic obstructive pulmonary disease (COPD). A recent systematic review concluded that interventions promoting self-management among COPD patients were effective in improving patients’ health outcomes, yet the most effective component of these interventions remains elusive. A better understanding of the underlying phenomenon of how COPD patients engage in self-management behaviors is urgently needed. The purpose of this study is to test the goodness-of-fit of an evidence-based theoretical model to explain the factors that affect selfmanagement behaviors in COPD patients.

Methods: A cross-sectional study employing a convenience sampling was conducted. Adult COPD patients were recruited when they had their follow-up visits in six clinics. Structural equation modeling was used to test the goodness-of-fit of the hypothesized model utilizing the EQS software. Model modifications were made based on theoretical plausibility and statistical significance.

Results: The findings revealed that ten factors exerted significant total effects on self-management behaviors: Eight of them had positive effects while two had negative effects. Among these significant factors, physical limitation had the greatest positive total effect on self-management behaviors, but the direction of the effect was contradicted to expectation. A further analysis on the relationships of self-management behaviors with functional limitations, dyspnea and fatigue suggested inverted U-shape non-linear relationships.

Conclusion: This newly developed evidence-based theoretical model provides insight into the understanding of the complex phenomenon of COPD patients’ engagement in self-management behaviors which could be used to guide the development of interventions to promote self-management behaviors in COPD patients.

Recommendations: Future study could replicate the current study and cross-validate the evidence-based theoretical model using a larger population of COPD patients with different ethnic origins, in particular, the non-linear relationship with severity of the disease.