Abstract
To explore opportunities for improving care based on the experiences and perspectives of different types of COPD patients based on the Information-Motivation-Behavioral skills (IMB) model with poor self-management behaviors. We used ethnographic methods (over 1000 h of observations for 30 participants), and conducted 34 semi-structured interviews with different patient profiles. Data were transcribed verbatim and analysed using thematic analysis. According to the IMB model, we divided participants into three categories, namely low-information and low motivation group, high information but low motivation group and low-information but strong motivation group. The first group had limited opportunities to acquire knowledge and decreased memory capacity. Also, patients did not feel the seriousness of COPD, or thought that self-management was not important, which led to the lack of self-management knowledge and motivation for this group of patients. In the second group, patients were pessimistic about the cure of the disease because of too much information or too much attention to the details of knowledge, which was also the reason why patients were unwilling to implement self-management although they had mastered enough knowledge. The third patient profile, with strong motivation, would seek health information resources through various channels. Because of this, they could easily acquire incorrect or unscientific information, which would make the situation worse. This qualitative study suggested COPD patients exhibited distinct self-management experiences, barriers, and recommendations due to variations in information processing and motivational characteristics. Future research should tailor precise self-management strategies based on individual patient profiles.
Introduction
Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease with no cure that can cause a range of symptoms including dyspnea, cough, expectoration and systemic inflammation, especially in the elderly1. Self-management has been advocated for mitigating disease progression, curbing medical costs, and enhancing health-related quality of life among COPD patients2. Despite the prevalent reports on the benefits of self-management, COPD patients continue to exhibit a suboptimal level of self-management skills. For example: In a study, researchers used the Chinese version of Chronic Disease Self-Management Study Program (CDSSP) to evaluate the self-management behaviors of COPD patients, which includes the frequency of exercise, cognitive symptom management, and communication with physician. Findings from this study showed that participants had a low level of self-management behaviors3. The factors contributing to this status are many and likely include the knowledge of self-management and the motivation to implement it, as advocated by the Information-Motivation-Behavioral skills (IMB) model: as individuals acquire knowledge regarding health management strategies and their motivation intensifies, they progressively master and refine the behavioral skills required for positive transformation. In essence, the IMB model highlights the pivotal role of these three components in fostering a proactive stance towards health management (Fig. 1)4. Among COPD patients exhibiting suboptimal self-management behaviors, a subset may possess limited self-management knowledge, some may be devoid of motivation for sustained self-care, while others may experience both these deficiencie5. Nevertheless, the self-management experiences and barriers faced by COPD patients lacking either information, motivation, or both, may vary significantly. Qualitative research may help improve the quality of care that people receive through providing a detailed and nuanced picture of their experiences. However, previous qualitative studies have primarily focused on exploring the experiences and barriers of self-management among COPD patients. The results showed that the main barriers to the low self-management ability of COPD patients was the limited understanding of self-management knowledge or related to patients’ negative emotions, and emphasized the importance of health literacy and psychological counseling from their family6,7. However, these previous studies did not notice the differences between COPD patients. For example, a study showed that even if patients had a wealth of self-management knowledge, their self-management ability was still low5. This showed that there were other factors affecting self-management ability in COPD patients. An in-depth analysis of patients with varying factors of self-management barriers and the differences in their self-management experiences and barriers has not been conducted.
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