Review paperSelf-management and behaviour modification 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.
Section snippets
Acquisition of knowledge
Table 1 presents the results of COPD studies that have assessed self-management program and patients’ knowledge. A number of approaches have been used to evaluate an individual’s disease knowledge. The most common method of disease knowledge assessment is with the administration of questionnaires. The Pulmonary Rehabilitation Health Knowledge Test is the only published validated questionnaire that assesses COPD patient’s knowledge. This questionnaire is a self-administered multiple-choice test
Mechanism underlying self-efficacy
There is sufficient empirical evidence to support the notion that behavioural performance and patient’s belief in their ability to perform in varied situations and disease states are linked by self-efficacy. In 1977, Bandura [12] coined the term self-efficacy, which refers to a person’s belief regarding whether or not they feel they can successfully execute particular behaviours in order to produce certain outcomes. Bandura has advised that the scale of perceived self-efficacy should be
Self-management and behaviour modification
Self-management requires the knowledge and skills needed to devise, evaluate and implement one’s own individual plan for health behaviour changes. Until now, studies are available in which self-management programs have been shown to influence health status in COPD patients [1], [2], [3], [4]. Few studies, however, have examined the specific behavioural changes in these patients that contribute to the health effects. In order to design more effective programs, we need to know: (1) which
Discussion and conclusion
Human behaviour is part of a complex causal chain, so many factors have to be considered when planning health intervention. Patients may be limited to perform a given behaviour because of knowledge and skill deficits. Improving knowledge is necessary, but insufficient alone. Patients need to know less about the pathophysiology of their disease and more about how to integrate the demands of the disease into their daily routine. Behaviour modification implies the appropriate use of many
Acknowledgements
The research projects of a disease specific self-management “Living well with COPD” have been supported by an unrestricted grant from Boehringer Ingelheim, Canada in partnership with the Fonds de la Recherche en Santé du Québec (FRSQ) and l’association pulmonaire du Québec (APQ).
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Recipient of a research scholarship.