Exploratory trial for examining effects of self-management education programme on patients with chronic obstructive pulmonary disease in Macau
Ng, Wai I
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Background: Respiratory disease has been one of the top three causes of deaths in Macau in the past decade. As one of the chronic respiratory diseases, chronic obstructive pulmonary disease (COPD) is incurable, but is preventable and treatable. COPD patients suffer from recurrent and progressive respiratory symptoms, and this impacts the health and well-being of patients. Self-management education programmes (SMEP) provide teaching and learning guidance for understanding COPD, emotional support and behaviour change needed to carry out disease-specific care in chronic patients. Evidence has demonstrated that SMEP can mediate a change in health-related behaviours, improve symptom control and the quality of life of COPD patients, with an associated reduction in health care utilization. However, SMEP has never been conducted in Macau, and experiences of providing any form of chronic care for COPD patients in this place is lacking. Aims: This study aimed to explore the effects of a specifically designed self-management education programme on Stage II to IV COPD patients in Macau. Design: The study was conducted as an exploratory randomized controlled trial in a mixed methods approach. Both illness perception and self-efficacy beliefs were adopted to formulate the theoretical framework. In the quantitative strand, the assessment of primary outcomes included illness perception, self-efficacy and inhaler technique. The secondary outcomes included pulmonary function, healthcare utilization and health-related quality of life. In the qualitative strand, focus groups were conducted to explore the subjective perception and experiences of self-management of COPD patients. Fifty one eligible COPD patients were recruited and allocated to experimental (26 patients) and control group (25 patients) by block randomization. A SMEP for COPD patients was developed and validated according to Medical Research Council (MRC) framework. Results: Quantitative results indicated that the primary outcomes (illness perception, self-efficacy and inhaler technique) improved in the experimental group after the SMEP. In relating to the secondary outcomes, days of hospitalization were reduced and symptom dimension of disease-specific health related quality of life (St. George Respiratory Questionnaire) improved. Qualitative findings identified the emergence of a core theme ‘Essentiality’ and five sub-themes ‘Helplessness’, ‘Mutual involvement’, ‘Support’, ‘Control’ and ‘Beneficial’, indicating perception and experiences of participants for self-management. These findings indicate a potential relationship of illness perception and self-efficacy in guiding COPD patients to adapt to health-related behaviour. Discussion and Conclusion: This study has obtained evidence for supporting the proposed theoretical framework and expected experimental effect through employing the MRC guidelines. The study also confirms the estimates of recruitment for a definitive RCT, demonstrated readiness and positive impact in Macau COPD patients to receive self-management intervention, and SMEP as an acceptable and preferable mode of chronic care for COPD for the healthcare system of Macau.