Self-management and behaviour modification in COPD

Abstract

There is new evidence from recent studies that disease-specific self-management improves health status and reduces hospital admissions in COPD patients. It is critical to implement health education programs in the continuum of care aimed at behaviour modification. Studies in COPD have shown that self-management increases knowledge and skills the patients require to treat their own illness. It is also essential to be more effective in improving patients’ confidence in their ability to follow a self-care regimen, for example, by augmenting self-efficacy. Self-efficacy plays a part in determining which activities or situations an individual will perform or avoid. Results from a recent qualitative study suggested that a continuum self-management program helps COPD patients to perform given self-health behaviours. COPD patients have perceived barriers and factors (disease-related skills), which will hinder or facilitate lifestyle modification. To be successful, self-management does require a multifaceted approach that incorporates not only teaching various disease contents but also implementing strategies to change behaviour in patients. Further research is needed to develop strategies on how to intervene and facilitate behaviour modification in chronic disease and as such the relevance for the implementation of self-management programs in COPD.

Introduction

Self-management applies to any formalised patient education program aimed at teaching skills needed to carry out specific medical regimens specific to the disease and guide health behaviour change for patients to control their disease and improve their well-being.

Although the number of published trials on self-management in COPD is limited, there is now evidence to suggest that it can improve health status [1], [2], [3], [4], reduce emergency visits [4], [5] and hospitalisations [4]. On the basis of the positive effect of self-management in COPD, self-management should assume a greater role in the continuum of COPD care.

To date, the benefits of self-management have been measured by changes in health status and the use of health services. To attain improvements in health status and reduce the use of health services in COPD patients, it is critical to implement health education programs in the continuum of care [4] aimed at behaviour modification. Behaviour modification implies the appropriate use of many disease-related skills such as inhalation techniques, self-use of a prescription as part of an action plan when the patient has an exacerbation, lifestyle behaviours such as smoking cessation, regular exercise, diet and sleep habits. Self-management can be described as a set of skilled behaviours and refers to the various tasks that a person carries out for management of their condition. Teaching of self-management skills is not enough to bring about change in behaviour; the patient should learn to integrate these skills in his everyday life. As these skills are performed with success in various situations, the person develops a sense of self-efficacy which is the confidence an individual has in response to specific actions and his or her ability to perform these actions [6]. Self-efficacy will play a part in determining which activities or situations a person will perform or avoid. We can argue that the effects of a self-management program on health status and health care utilisation results from behaviour change, which in turn is caused by enhancement of both self-efficacy, knowledge and skill. Although this is a rather complex causal chain, Fig. 1 depicts a simple illustration of this model.

This article presents and discusses self-management in COPD and assessing patients’ knowledge, disease-related skill, self-efficacy, and behaviour modification. New study results are presented in support of self-management and behaviour modification in COPD patients.