A health coaching self-management programme for patients with Chronic Obstructive Pulmonary Disease : An explorative and interventional study

Abstract: Background: Chronic Obstructive Pulmonary Disease (COPD) is a primary cause of chronic morbidity and mortality and contributes to an increased economic and social burden on patients and families. Self-management education as one non-pharmacological treatment approach is highlighted in guidelines. Although self-management programmes have shown positive effects for COPD, lack of disease-specific self-management skills, high dropout rates, and poor attendance of participants are problems which should be taken under consideration. One way to cope with the problems is to use amore motivational approach which focuses on patients’ health decisions in cooperation with healthcare practitioners, combined with systematic and structured health coaching. However, there is a lack of such studies, which are needed to explore the effects of self-management on patients with COPD by health coaching, not least in China.Aims: The overall aim of this thesis was to explore sociodemographic and clinical factors influencing self-management and to test and evaluate a health coaching self-management programme for patients with COPD in China.Methods: The study’s design was explorative, prospective, and longitudinal, with both quantitative and qualitative approaches. Specifically, a quantitative method with a cross-sectional approach was used to explore the self-management status of patients with COPD and examine the associations with socio-demographic and clinical variables (I). Furthermore, a prospective randomized controlled trial was conducted to study the longitudinal effects of the health coaching self-management programme using a repeated-measures analysis of variance model of patients with COPD (II & III). A qualitative study implementing inductive content analysis was used to describe and explore participants’ experiences of the health coaching self-management programme of patients with COPD (IV).Results: High physical activity, high salary, and low age affected the self-management of patients with COPD most positively (I). The health coaching programme improved lung function, physical activity, quality of life, and self-management skills, as well as psychological status in both the short and long term (II & III). Participants expressed their experiences of the health coaching self-management programme as making them more aware of the importance of knowledge of the disease and their own responsibilities, taking action to maintain a healthy lifestyle, feeling supported by the programme, and being hindered by individual and programme limitations (IV).Conclusions: This thesis contributes to knowledge about the self-management skills of patients with COPD, which is low in China. A health coaching self-management programme with iterative interactions between patients and healthcare professionals represented a valuable and effective intervention designed to improve health-related outcomes. Moreover, low literacy, poor physical condition, and family and economic burdens should be taken into account in the development of future self-management programmes in China.