Barriers and facilitators influencing self-management among COPD patients: a mixed methods exploration in primary and affiliated specialist care

Figures & data

Figure 1 Influencing factors of self-management.

Figure 2 Flowchart of research approach.

Abbreviation: GPI, general practice institute.

Table 1 Patient feedback questionnaire on consultation skills; 4-point scale (completely, mostly, a little, not at all)

1. To what extent was your main problem(s) discussed today?

2. How satisfied were you with the discussion of your problem?

To what extent did:

3. The health care provider listen to what you had to say?

4. The health care provider explain this problem to you?

5. You and the health care provider discuss your respective roles?

6. The health care provider explain the treatment?

7. The health care provider explore how manageable this treatmentwould be for you?

8. How well do you think your health care provider understood you today?

9. To what extent did the health care provider discuss personal or family issues that might affect your health?

10. To what extent was there an atmosphere of trust during the consultation?

To what extent did:

11. The health care provider show his/her concern?

12. The health care provider invite you to ask all the questions you wanted to ask?

13. The health care provider give you clear information and explanation?

14. The health care provider act in a structured way?

15. The health care provider give you new or better insight into your problem?

16. The health care provider give you clear treatment advice?

Table 2 Patients’ social and demographic characteristics (N=46)

Patients’ characteristics	Patients
Institute, n (%)
General practice 1	3 (6.5)
General practice 2A	6 (13.0)
General practice 2B	4 (8.7)
General practice 3	9 (19.6)
Outpatient clinic 1	9 (19.6)
Outpatient clinic 2	8 (17.4)
Outpatient clinic 3	7 (15.2)
Gender, n (%)
Male	28 (60.9)
Female	18 (39.1)
Age in years, mean (range)	70 (53–87)
Duration of disease in years, mean (range)	6.3 (0.2–20)
CCQ score, mean (range)	1.9 (0.3–4.7)
GOLD scale, n (%)
GOLD 1	10 (21.7)
GOLD 2	18 (39.1)
GOLD 3	12 (26.1)
GOLD 4	5 (10.9)
Missing data	1 (2.2)
Employment status, n (%)
Working	9 (19.6)
Retired	22 (47.8)
Not working, not retired	13 (28.3)
Missing data	2 (4.3)
Marital situation, n (%)
Single	15 (32.6)
Living together	29 (63.0)
Missing data	2 (4.3)
Ethnicity, n (%)
Dutch	43 (93.5)
Missing data	3 (6.5)
Exercise, n (%)
Less than 30 minutes per day	7 (15.2)
30 minutes per day	10 (21.7)
More than 30 minutes per day	26 (56.5)
Missing data	3 (6.5)
Educational level, n (%)
None	2 (4.3)
Elementary school or low vocational education	23 (50.0)
Secondary school or intermediate vocational education	9 (19.6)
Higher vocational education or university	10 (21.7)
Missing data	2 (4.3)
Support from caregiver, n (%)
Poor support	3 (6.5)
Moderate support	8 (17.4)
Support	6 (13.0)
Good support	16 (34.8)
Missing data	13 (28.3)

Abbreviations: CCQ, Clinical COPD Questionnaire; GOLD, Global Initiative for Chronic Obstructive Lung Disease.

Table 3 Health care providers’ social and demographic characteristics

Health care providers’ characteristics	Total health care providers (N=11)	Health care providers (%)	Total observations (N=50)*	Observations (%)
Institute
General practice 1	2	18.2	5	10.0
General practice 2A	1	9.1	6	12.0
General practice 2B	1	9.1	4	8.0
General practice 3	1	9.1	9	18.0
Outpatient clinic 1	2	18.2	9	18.0
Outpatient clinic 2	2	18.2	10	20.0
Outpatient clinic 3	2	18.2	7	14.0
Occupation
Pulmonologist	3	27.3	13	26.0
Pulmonary nurse specialist	3	27.3	13	26.0
General practitioner	1	9.1	2	4.0
Nurse practitioner	2	18.2	10	20.0
Practice nurse	2	18.2	12	24.0
Gender
Male	2	18.2
Female	9	81.8
Age in years, mean (range)	44 (28–56)
Work experience in years, mean (range)	20 (7–39)
Work experience in pulmonary disease in years, mean (range)	9 (3–20)
Working hours per week, mean (range)	33 (20–50)

Note:

* Fifty videotaped observed consultations were obtained from 46 patients and 11 HCPs (4 patients had a second consult).

Figure 3 Key topics of interviewed patients.

Figure 4 Key topics of interviewed health care providers (HCPs).

Table 4 Answering pattern and response rate for the patient feedback questionnaire on consultation skills (%)

Question	Completely		Mostly		A little		Not at all		Nonresponse
	Pt	HCP	Pt	HCP	Pt	HCP	Pt	HCP	Pt	HCP
1	90	34	6	60	0	6	0	0	4	0
2	96	38	2	52	0	10	0	0	2	0
3	96	34	0	62	0	2	0	0	4	2
4	92	8	4	62	0	28	0	0	4	2
5	80	24	10	46	0	30	0	0	10	0
6	78	16	6	48	0	18	4	6	12	12
7	58	12	8	60	0	22	4	4	30	2
8	92	18	2	56	0	24	0	0	6	2
9	78	18	6	50	2	22	2	10	12	0
10	96	56	0	42	0	2	0	0	4	0
11	90	44	4	54	0	2	0	0	6	0
12	86	36	4	46	0	14	0	4	10	0
13	94	34	2	64	0	2	0	0	4	0
14	90	26	6	52	0	20	0	0	4	2
15	60	4	14	40	4	40	6	10	16	6
16	72	22	8	58	0	14	4	0	16	6
Mean (%)	84.3	26.5	5.1	53.3	0.4	16.0	1.3	2.1	9.0	2.1

Notes: N=50 consultations. Question details are available in Table 1.

Abbreviations: HCP, health care provider; Pt, patient.

Figure 5 PFC scores of patient and HCP (mean/SD).

Note: Question details are available in Table 1.
Abbreviations: HCP, health care provider; PFC, patient feedback questionnaire on consultation skills; SD, standard deviation.