Enhancing Confidence and Coping with Stigma in an Ambiguous Interaction with Primary Care: A Qualitative Study of People with COPD

Abstract

Meaningful and high-quality interactions between people with COPD and healthcare professionals are essential to accomplish effective and efficient self-management.

This study’s aim was to explore how people with COPD experience COPD-related interactions with healthcare professionals in primary care, and how these interactions influence their self-management and how they cope with their disease.

Interviews were performed with eight women and five men with COPD, and grounded theory guided data collection and analysis.

The analysis resulted in a theoretical model and the core category (Re)acting in an ambiguous interaction, representing a dynamic process in which healthcare priorities, healthcare professionals’ attitudes and participants’ personal emotions were important for the participants’ experiences of interactions, and how they managed and coped with their disease.

Mutually respectful and regular relationships with healthcare professionals, along with a personal positive view of life, empowered and facilitated participants to accept and manage their disease. In contrast, experiences of being deprioritized and not taken seriously, along with experiences of fear and stigma, disempowered and inhibited participants in making healthcare contacts or forced them to compensate for experienced insufficiencies in primary care.

In order to facilitate meaningful and high-quality interactions and enhance patient-provider partnerships in primary care, there is a need to improve the status of COPD, as well as to increase competence in COPD management among healthcare professionals and support the empowerment of people with COPD. Findings from this study could guide the implementation of improved self-management support in primary care for COPD and other chronic conditions.

Keywords:

• Empowerment
• self-management
• healthcare professionals
• grounded theory
• ambiguity
• chronic disease
• encounters

Acknowledgments

We gratefully acknowledge the participants who informed this study and the COPD nurses who helped out with the recruitment of participants. We also want to thank Associate Professor Anna-Britt Coe at the Department of Sociology at Umeå University for her valuable input on the grounded theory analysis.

Disclosure of interest

The authors report no conflict of interest.

Data availability

Quotes supporting the findings are available within the manuscript. Additional quotes from the transcripts are available from the corresponding author on reasonable request. However, entire interview transcripts will not be shared to ensure confidentiality, and since consent for this have not been obtained from the participants neither from the Regional Ethical Board.

Author contributions

KW, SL and MT contributed to the planning and design of the study. SL and MT collected the data. SL performed the analysis in recurrent discussions with MT and MW. KW was involved in discussions of the final analysis and model. SL was main responsible for writing the manuscript in cooperation with all authors; and all authors contributed to the revision and approved the final manuscript.

Author information

SL is a physiotherapist (RPT) and PhD. She has experience in COPD, mainly from qualitative research and clinical work in primary care.

MW is a RPT and PhD. She has extensive competence in qualitative research, medical sociology and mental health.

KW is a RPT and professor. She has extensive competence in research concerning COPD and clinical work in COPD specialty care.

MT is a RPT and PhD. She has experience conducting qualitative health services research on management of stroke and COPD in primary care.

Additional information

Funding

This work was supported by The Swedish Research Council (Dnr: 521-2013-3503), The Swedish Heart and Lung Foundation (Dnr: 20130331), The Swedish Heart and Lung patient association (Dnr: E114/12) and King Gustaf the 5th and Queen Victoria’s Freemasons Foundation.