Understanding COPD Patients' Barriers to Behavioural and Lifestyle Changes Using a Resilience, Readiness to Change, and Self-Management Model

Abstract

Chronic obstructive pulmonary disease is a preventative degenerative illness of the lungs characterised by persistent airflow limitation. Currently chronic obstructive pulmonary disease is the fourth leading cause of death worldwide, with predictions that it will increase to become the third leading cause of death by 2030. Australian treatment recommendations, based upon the global treatment strategy, suggest a five-step plan for chronic obstructive pulmonary disease patients to manage their disease and its disturbances. Within these recommendations is a set of behavioural and lifestyle changes that includes adopting a self-management approach, undertaking pulmonary rehabilitation, and adhering to medication regimens. Unfortunately, research has identified that adherence to these behavioural and lifestyle changes is low, which can impact upon chronic obstructive pulmonary disease patients’ health outcomes and quality of life. Studies on the barriers for adherence to these recommendations have found a diverse range of reasons that patients report for not undertaking or continuing with these behavioural and lifestyle changes. These barriers include not feeling ready, poor self-efficacy, and lack of support. Although various psychological, physiological, and social factors have been identified, these barriers are yet to be quantitatively examined. This thesis aimed to examine Australian chronic obstructive pulmonary disease patients’ barriers to behavioural and lifestyle changes via a resilience, readiness to change, and self-management model. The studies investigated: (1) the effect of self-management programs on chronic obstructive disease patients’ health-related quality of life via a meta-analysis; (2) the relationships between chronic obstructive disease patients’ levels of resilience and their health-related quality of life; (3) the association between patients’ levels of resilience and their adherence to pulmonary rehabilitation programs; (4) the relationships between chronic obstructive disease patients’ levels of resilience and readiness to change and their adherence to medication regimens; (5) the validity and reliability of the St George’s Respiratory Questionnaire on Australian chronic obstructive disease patients. One hundred and fifty-nine chronic obstructive pulmonary disease patients were recruited from the Gold Coast University and Robina hospitals, and through education seminars with the Lung Foundation Australia held in Brisbane, and Gold Coast community health centres (Helensvale and Robina). These participants completed a questionnaire enquiring into their individual and contextual resilience, readiness to change, health-related quality of life, and various demographic variables. Resilience was examined via three measures: a disease specific grief questionnaire (Acceptance of Disease and Impairments questionnaire) which analysed defensive coping and disease specific self-esteem; the Connor-Davidson Resilience scale; and the Pulmonary Rehabilitation Benefits and Consequences Scale (professional support; developed for this study). Patients’ readiness to change was assessed via a modified version of the Readiness to Change questionnaire (originally devised in relation to alcohol consumption). Health-related quality of life was measured by the St George’s Respiratory Questionnaire. All measures were refactored, validated, and assessed for reliability in this study. Associations between the variables were examined via bivariate and decision tree analyses. The results identified that: (1) self-management interventions significantly improved chronic obstructive disease patients’ health-related quality of life, especially when disease specific education, exercise information, and an exacerbation action plan were included in the program; (2) all individual and contextual resilience factors were important for chronic obstructive pulmonary disease patients’ health-related quality of life (breathlessness, symptoms, and cough domains); (3) chronic obstructive disease patients’ levels of resilience (self-efficacy, self-esteem, decision making, coping, defensive coping, relationships, and professional support) were important for their referral to and completion of pulmonary rehabilitation programs; (4) chronic obstructive pulmonary disease patients’ trust, coping, self-esteem, decision making abilities, level of support and readiness to change were important for their adherence to medications; (5) the St George’s Respiratory Questionnaire, once refactored, was a valid and reliable measure for Australian chronic obstructive pulmonary disease patients. Combined, the results of this thesis identify that low levels of individual and contextual resilience, and poor readiness to change are barriers to chronic obstructive pulmonary disease patients’ adherence to behavioural and lifestyle changes. It was also identified that undertaking a self-management approach can improve patients’ health-related quality of life, and that health-related quality of life is important for chronic obstructive pulmonary disease patients’ resilience. In all, it was found that a patient’s relationships and their sense of self, in particular their self-esteem and self-efficacy, were highly important for their adherence to these behavioural and lifestyle changes. Thus, this thesis has established that chronic obstructive pulmonary disease patients’ individual and contextual resilience factors were related to their health-related quality of life and pulmonary rehabilitation referral and completion. Further to this, it was identified that patients’ medication adherence was associated with their resilience and readiness to change. Given that these relationships have been identified, strategies need to be implemented in clinical settings to provide chronic obstructive pulmonary disease patients with additional support that focuses on increasing patient empowerment and collaboration within the patient—clinician relationship. Finally, these research topics need to be undertaken in an experimental context so that causal relationships can be identified between resilience, readiness to change, and the behavioural and lifestyle changes that are recommended to chronic obstructive pulmonary disease patients.