Chronic Obstructive Pulmonary Disease
Framework for the Evaluation of Chronic Obstructive Pulmonary Disease Self-management Interventions
Emmylou Beekman,1 Rob de Bie2 and Onno van Schayck2
1. PhD Student, Physical Therapist and Human Movement Scientist; 2. Professor, Department of Epidemiology, Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre
Abstract
There is a noted lack of consistency in the use of the term ‘self-management’, which hinders by definition the advancement of the field. Despite the lack of a generally agreed definition or framework of self-management support interventions, a growing enthusiasm is noted for self-management support interventions in patients with chronic obstructive pulmonary disease (COPD). Although many core elements and strategies are present in the literature, more insight into the connections and the related actions between these elements is needed to understand how or why interventions work or fail to produce anticipated results. A compilation of different models, core elements and strategies in one working model could be the solution.
Keywords Chronic obstructive pulmonary disease (COPD), self-management, self-management support interventions, core elements, model, framework
Disclosure: The authors have no conflicts of interest to declare. Received: 16 August 2011 Accepted: 1 September 2011 Citation: European Respiratory Disease, 2011;7(2):131–3 Correspondence: Emmylou Beekman, Department of Epidemiology, Maastricht University/CAPHRI School for Public Health and Primary Care, PO Box 616, 6200 MD Maastricht, The Netherlands. E:
e.beekman@
maastrichtuniversity.nl
Given that chronic obstructive pulmonary disease (COPD) is a leading cause of progressive morbidity and mortality,1
and the fact that
treatment success largely depends on patients’ behaviour, interest in self-management interventions has naturally increased. Self-management interventions are often aimed at symptom-reducing behaviours, such as smoking cessation, self-treatment of exacerbations and the optimal inhalation technique.2
Equally important, but less
addressed in research, are self-management interventions aimed at physical activity. However, regular physical activity has been linked consistently and reliably to a reduction in hospital admission owing to COPD and all-cause and respiratory mortality.3
In addition to the
beneficial effects of physical activity on health, regular physical activity also improves older adults’ ability to perform their daily activities, thus enhancing their quality of life.4
A healthcare initiated Encouraging a healthy active lifestyle is
therefore an important element of care in the treatment of patients with COPD, to enable them to gain health benefits related to their specific medical condition, quality of life and well-being.5–7
self-management support intervention is one way to accomplish this behavioural goal.
Definitions and Models
The term ‘self-management’ originates from the early writing of Bandura and the interpretation of Creer and colleagues during the mid-1960s, who felt that the patient was an active participant in treatment.8
Since then, the term has been widely used and authors have tried to conceptualise and define self-management. A single wide-ranging definition of self-management given by Barlow is: “Self-management refers to the individual’s ability to manage the symptoms, treatment, physical and psychosocial consequences and
© TOUCH BRIEFINGS 2011
lifestyle changes inherent in living with a chronic condition. Efficacious self-management encompasses ability to monitor one’s condition and to affect the cognitive, behavioural and emotional responses necessary to maintain a satisfactory quality of life. Thus, a dynamic and continuous process of self-regulation is established.”9
In
a more narrow definition by Bourbeau, self-management is a “term applied to any formalised patient education program aimed at teaching skills needed to carry out medical regiments specific to the disease, guide health behaviour change, and provide emotional support for patients to control their disease and live functional lives. This continuum of self-management training and support services can go from self-help approaches to more intensive case management.”10
In the framework of Corbin and Strauss, a problem-based self-management approach comprises three self-management tasks: medical management, role management and emotional management.11 However, most health promotions and patient education programmes only deal with the medical or behavioural management tasks.8
Based on
the work of Lorig and colleagues, six core self-management skills can be identified: problem-solving; decision-making; resource use; forming a patient–care provider partnership; taking action; and self-tailoring.8 The above examples therefore illustrate that, when the concept of self-management is used, one has to check carefully what is meant by it in that specific context. Given that self-management concerns patient behaviour, interventions provided by care providers should be regarded as self-management support interventions. According to the Chronic Care Model (CCM), self-management support is an important component of successful chronic disease care management, for example to stimulate a healthy active lifestyle, but not solely. Chronic
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