Understanding patient participation behaviour in studies of COPD support programmes such as pulmonary rehabilitation and self-management: a qualitative synthesis with application of theory

NPJ Prim Care Respir Med. 2015 Sep 17:25:15054. doi: 10.1038/npjpcrm.2015.54.

Abstract

Background: In chronic obstructive pulmonary disease (COPD), the problem of poor patient participation in studies of self-management (SM) and pulmonary rehabilitation (PR) programmes (together referred to as COPD support programmes) is established. Understanding this problem beyond the previously reported socio-demographics and clinical factors is critical.

Aims: The aim of this study was to explore factors that explain patient participation in studies of COPD support programmes.

Methods: Thematic 'framework' synthesis was conducted on literature published from 1984 to 1 February 2015. Emergent themes and subthemes were mapped onto the adapted 'attitude-social influence-external barriers' and the 'self-regulation' models to produce analytical themes.

Results: Ten out of 12 studies were included: PR (n=9) and SM (n=1). Three descriptive themes with 38 subthemes were mapped onto the models' constructs, and it generated four analytical themes: 'attitude', 'social influences' and 'illness' and 'intervention representations'. The following factors influenced (1) attendance-helping oneself through health improvements, perceived control of worsening condition, perceived benefits and positive past experience of the programme, as well as perceived positive influence of professionals; (2) non-attendance-perceived negative effects and negative past experience of the programme, perceived physical/practical concerns related to attendance, perceived severity of condition/symptoms and perceived negative influence of professionals/friends; (3) dropout-no health improvements perceived after attending a few sessions of the programme, perceived severity of the condition and perceived physical/practical concerns related to attendance.

Conclusions: Psychosocial factors including perceived practical/physical concerns related to attendance influenced patients' participation in COPD support programmes. Addressing the negative beliefs/perceptions via behaviour change interventions may help improve participation in COPD support programmes and, ultimately, patient outcomes.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Patient Dropouts
  • Patient Participation / psychology*
  • Psychological Theory
  • Pulmonary Disease, Chronic Obstructive / psychology*
  • Pulmonary Disease, Chronic Obstructive / rehabilitation
  • Respiratory Therapy / psychology*
  • Self Care / psychology*