Development of a training program to support health care professionals to deliver the SPACE for COPD self-management program

Abstract

Background

With the growing burden of COPD and associated morbidity and mortality, a need for self-management has been identified. The Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD) manual was developed to support self-management in COPD patients. Currently, there is no literature available regarding health care professionals’ training needs when supporting patients with COPD on self-management.

Aim

This study sought to identify these needs to inform, design and develop a training program for health care professionals being trained to deliver a self-management program in COPD.

Methods

Fourteen health care professionals from both primary and secondary care COPD services participated in face-to-face semistructured interviews. Thematic analysis was used to produce a framework and identify training needs and views on delivery of the SPACE for COPD self-management program. Components of training were web-based knowledge training, with pre-and posttraining knowledge questionnaires, and a 1-day program to introduce the self-management manual. Feedback was given after training to guide the development of the training program.

Results

Health care professionals were able to identify areas where they required increased knowledge to support patients. This was overwhelming in aspects of COPD seen to be outside of their current clinical role. Skills in goal setting and behavioral change were not elicited as a training need, suggesting a lack of understanding of components of supporting self-management. An increase in knowledge of COPD was demonstrated following the training program.

Conclusion

Both knowledge and skill gaps existed in those who would deliver self-management. Analysis of this has enabled a training program to be designed to address these gaps and enable health care professionals to support patients in self-management.

Keywords:

• self-management
• COPD
• health care professionals
• training
• development

Supplementary materials

Interview schedule

Interview schedule for health care professional interviews

Gain consent and introduction

Introduce yourself, name and role

You have consented to taking part in an interview, which is an informal chat with me. We will be discussing issues regarding self-management, COPD, delivery of the self-management manual for patients with COPD and training needs regarding this.

Do you have any questions?

Are you happy with me to turn on the dictaphone to record the interview as it takes place?

For the benefit of the tape, it is … day … time and present there is me, … (the participant) and …

Before we start, I just have a few questions that you can answer yes or no to:

• Do you understand what the interview is about?

• Do you understand the purpose of the interview?

• Are you happy to take part in the interview and for it to be recorded?

Ground rules

Everything that is said during the next hour and a half is confidential. If, however, you do disclose any information that highlights a breach of the law or a dangerous practice, I will be duty bound to break confidentiality. This means that if during the session you tell me you have broken the law or done something dangerous that may result in harm to yourself or others, I will have to report to the necessary people.

Withdrawal

If anything we speak about today does make you feel uncomfortable you are free to not answer a particular question, request for the recorder to be switched off and to resume the interview after a short break or you can ask to terminate the interview all together at any point. If after this discussion has taken place you wish to remove your comments from the study, please contact me or another researcher on the study, and none of your comments will be taken into account when performing the analysis.

Current role/COPD strategies

• Can you tell me a little about what you do for patients with COPD whom you have contact with? Are there any current strategies you use? Anything you would like to be able to do with these patients? Do you see them regularly? What do you do when they are first diagnosed? Do you offer any interventions/support?

Self-management

• What do you understand by the term “self-management”? Patients independently doing something to help themselves. Self-management is the term given to the way persons manage their life and lifestyle to optimize their health, well-being and quality of life.

• Do you think self-management is important for patients with COPD? If yes, in what ways? If not, why not?

• How well do you think you currently help patients to self-manage their COPD? What do you do to help this? Any difficulties in doing this?

• Do you feel there are any barriers for patients to adopt self-management strategies? Lack of motivation? Do you find it difficult to motivate patients? How do you motivate patients? Unable/unwilling to take advice on board?

The manual

You have had a chance to look at the manual, is there anything you would like to comment on? Are there any areas within the manual that you feel you may need more knowledge on (look at contents page)? Is there anything in there you are unsure about – exercise/activity/medication/education or advice?

• How would you feel about introducing this manual to a patient with COPD? What barriers do you think you may have in doing this? What would you feel most confident in doing?

• How would you support patients who have this manual? Telephone calls to help patients? How would you feel about doing this – any barriers or help needed? Ongoing support?

• Would you assess or follow-up these patients to find out if they were benefiting from this manual? How would you do this? Formal or informal? Do you feel it is important to measure change in patients’ physical performance, quality of life or other aspect of their well-being? Would you measure a change in patient’s exercise levels, that is, walking tests? Would you use questionnaires or interviews to measure knowledge or Quality of Life? Any problems in doing this?

Training

Do you feel you would need help or training in order to deliver the manual to patients with COPD effectively? If so, why? What parts in particular? If no, why not?

• What would be the best way of delivering this training? On the job, observation, web-based, training day, telephone/email support? One-off training, few days or continued support?

• Do you feel you would need ongoing support or resources? If yes, in what ways? If no, why not? Best way to provide this?

• Any problems with being able to train? Time, cost, staff?

I have asked all the questions I would like to now. Do you have anything you feel like you would like to add?

Thank you very much for all your time and comments. I will turn off the dictaphone now.

Acknowledgments

The research was funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme (grant PB-PG-0808-17146) and East Midlands Collaboration for Leadership in Applied Health Research and Care (CLAHRC) and took place at the University Hospitals of Leicester NHS Trust. Support was also provided by the NIHR Leicester Respiratory Biomedical Research Unit (BRU). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

The authors would like to acknowledge the contribution made by Samantha Harrison for contributing to the early preliminary analysis of the transcript.

Disclosure

The authors report no conflicts of interest in this work.