Assessing the effect of culturally specific audiovisual educational interventions on attaining self-management skills for chronic obstructive pulmonary disease in Mandarin- and Cantonese-speaking patients: a randomized controlled trial

Figures & data

Table 1 Characteristics of study sample (n=91)

Characteristic	n (%)
Study and control groups
Group 1 (watched clinical video)	22 (24.2)
Group 2 (watched lay video)	26 (28.5)
Group 3 (watched both videos)	29 (31.8)
Group 4 (read pamphlet)	14 (15.4)
Sex
Female	20 (21.9)
Male	71 (78.1)
Agea
≤75 years old	37 (40.7)
>75 years old	54 (59.3)
Language
Mandarin	18 (19.8)
Cantonese	73 (80.2)
Educationb
Low education	42 (46.2)
High education	49 (53.8)
Disease severity
GOLD Stage I: Mild (FEV1 ≥ 80% predicted)	5 (5.5)
GOLD Stage II: Moderate (FEV1≥ 50 to <80% predicted)	31 (34.0)
GOLD Stage III: Severe (FEV1 ≥30 to <50% predicted)	46 (50.6)
GOLD Stage IV: Very severe (FEV1 <30% predicted)	9 (9.9)
Current smokers	40 (44)
Medications taken at home
Long-acting anticholinergic	55 (61.5)
ICS	12 (13.2)
Short-acting bronchodilators	76 (83.6)
LABA	9 (9.9)
Combination of ICS and LAB	79 (86.8)
Other medications	17 (18.7)
COPD action plan
Never received written action plan from doctor	69 (75.8)
Had received verbal information from doctor	16 (17.6)
Had received written action plan from doctor	6 (6.6)

Notes:

a Median age of the participants was 75 years.

b Low education, less than high school diploma, including those with no formal education. High education, a minimum of high school diploma.

Abbreviations: GOLD, Global Initiative for Chronic Obstructive Lung Disease; FEV₁, forced expiratory volume in 1 second; ICS, inhaled corticosteroids; LABA, long-acting β-agonists; COPD, chronic obstructive pulmonary disease.

Figure 1 Patient enrollment and attrition.

Abbreviation: COPD, chronic obstructive pulmonary disease.

Table 2 Inhaler technique – overall improvement in correct use and distinguishing inhalers, from baseline assessment to 3 months postintervention

Outcomes of interest (comparison of baseline assessment and 3-month postintervention assessment)	Mean difference from reference (95% CI)	t-statistic	Degrees of freedom	P-value
1. Correct usea
Group 1 compared to Group 4	2.34 (1.34, 3.34)	4.66	1.82	<0.001
Group 2 compared to Group 4	1.92 (0.91, 2.93)	3.77	1.82	<0.001
Group 3 compared to Group 4	2.13 (1.08, 3.18)	4.04	1.82	<0.001
Education (low vs high)	−0.59 (−1.16, −0.03)	−2.33	1.82	<0.05
Sex (male vs female)	0.53 (0.04, 1.01)	2.68	1.82	<0.05
Age (≤75 vs ≥76 years)	0.19 (−0.25, 0.63)	1.02	1.82	N/S
Disease severity (very severe vs mild)	−0.56 (−1.67, 0.56)	1.33	1.82	N/S
2. Differences between inhalers	Overall improvement from baseline assessment to 3 months postintervention
Group 1 compared to Group 4	0.18 (−0.14, 0.51)	0.98	1.82	N/S
Group 2 compared to Group 4	0.09 (−0.42, 0.33)	0.51	1.82	N/S
Group 3 compared to Group 4	0.20 (−0.44, 0.84)	0.43	1.82	N/S
Education (low vs high)	−0.11 (−0.44, 0.22)	−0.22	1.82	N/S
Sex (male vs female)	−0.03 (−0.27, 0.21)	−0.36	1.82	N/S
Disease severity	−0.17 (−0.72, 0.39)	0.69	1.82	N/S
Age (≤75 vs ≥76 years)	−0.35 (−0.69, –0.02)	−2.09	1.82	<0.05

Note:

a Inhaler technique improved significantly from pretest to 3-month postintervention follow-up at P<0.001.

Abbreviations: CI, confidence interval; N/S, not significant.

Table 3 Inhaler technique: mean summary score out of 10

Intervention group	Baseline		3-month follow-up
	Mean	SD	Mean	SD
Group 1 (watched clinical video)	4.0	2.1	6.8	2.0
Group 2 (watched lay video)	4.5	2.0	5.9	2.0
Group 3 (watched both videos)	3.9	2.1	5.8	1.6
Group 4 (read pamphlet)	4.8	2.3	5.2	1.4
All patients	4.4	2.0	6.3	1.8

Abbreviation: SD, standard deviation.

Table 4 Self-efficacy – overall improvement from baseline assessment to 3 months postintervention

Outcomes of interest (comparison of baseline assessment and 3-month postintervention assessment)	Mean difference from reference (95% CI)	t-statistic	Degrees of freedom	P-value
1. Prepared to manage COPD exacerbationa	Overall improvement from baseline assessment to 3 months postintervention
Group 1 compared to Group 4	1.2 (0.38, 2.02)	2.91	1.82	<0.01
Group 2 compared to Group 4	0.96 (0.09, 1.82)	2.09	1.82	<0.05
Group 3 compared to Group 4	0.87 (0.04, 1.71)	2.20	1.82	<0.05
Education (low vs high)	−0.56 (−1.30, 0.19)	−0.74	1.82	N/S
Sex (male vs female)	−0.03 (−0.27, 0.21)	−0.04	1.82	N/S
Age (≤75 vs ≥76 years)	0.25 (−0.24, 0.75)	0.85	1.82	N/S
Disease severity	0.10 (−1.13, 1.34)	0.61	1.82	N/S
2. Perception of being informed about COPDb	Overall improvement from baseline assessment to 3 months postintervention
Group 1 compared to Group 4	0.53 (−0.21, 1.28)	0.69	1.82	N/S
Group 2 compared to Group 4	0.36 (−0.40, 1.13)	0.91	1.82	N/S
Group 3 compared to Group 4	0.12 (−0.65, 0.90)	1.93	1.82	<0.05
Age (≤75 vs ≥76 years)	−0.42 (−0.74, –0.06)	−1.73	1.82	<0.05
Education (low vs high)	−0.59 (−1.11, –0.09)	−1.98	1.82	<0.05
Sex (male vs female)	−0.10 (−0.48, 0.27)	−0.71	1.82	N/S
Disease severity	0.58 (−0.28, 1.44)	0.58	1.82	N/S
3. Remain calm when facing a COPD worseningc	Overall improvement from baseline assessment to 3 months postintervention
Group 1 compared to Group 4	0.40 (−0.38, 1.18)	1.35	1.82	N/S
Group 2 compared to Group 4	0.80 (0.02, 1.58)	2.72	1.82	<0.05
Group 3 compared to Group 4	0.28 (−0.54, 1.11)	1.55	1.82	N/S
Education (low vs high)	−0.18 (−0.72, 0.37)	−1.18	1.82	N/S
Sex (male vs female)	0.33 (0.02, 0.65)	2.12	1.82	<0.05
Age (≤75 vs ≥76 years)	0.24 (−0.12, 0.60)	0.90	1.82	N/S
Disease severity	−0.34 (−1.24, 0.55)	0.82	1.82	N/S
4. Ability to achieve goals in managing COPDd	Overall improvement from baseline assessment to 3 months postintervention
Group 1 compared to Group 4	1.28 (0.36, 2.19)	2.02	1.82	<0.05
Group 2 compared to Group 4	0.93 (−0.02, 0.88)	1.62	1.82	N/S
Group 3 compared to Group 4	1.05 (0.08, 2.02)	1.98	1.82	<0.05
Education (low vs high)	−0.78 (−1.54, −0.01)	−2.69	1.82	<0.05
Sex (male vs female)	−0.05 (−0.60, 0.49)	0.06	1.82	N/S
Age (≤75 vs ≥76 years)	0.27 (−0.24, 0.77)	1.39	1.82	N/S
Disease severity	−0.88 (−2.13, 0.37)	0.94	1.82	N/S
5. Ability to self-manage COPD symptoms	Overall improvement from baseline assessment to 3 months postintervention
Group 1 compared to Group 4	0.14 (−0.61, 0.90)	1.09	1.82	N/S
Group 2 compared to Group 4	0.24 (−0.54, 1.02)	1.03	1.82	N/S
Group 3 compared to Group 4	0.38 (−1.18, 0.41)	1.96	1.82	<0.05
Sex (male vs female)	−0.44 (−0.87, –0.02)	−1.04	1.82	<0.05
Education (low vs high)	−0.29 (−0.87, 0.30)	−0.99	1.82	N/S
Age (≤75 vs ≥76 years)	−0.08 (−0.47, 0.31)	−0.31	1.82	N/S
Disease severity	0.68 (−0.29, 1.64)	1.19	1.92	N/S

Notes:

a Prepared to manage COPD exacerbation improved significantly from pretest to 3-month postintervention follow-up at P<0.001.

b Being informed improved significantly from pretest to 3-month postintervention follow-up at P<0.05.

c Remain calm improved significantly from pretest to 3-month postintervention follow-up at P<0.05.

d Achieve goals in managing COPD improved significantly from pretest to 3-month postintervention follow-up at P<0.001.

Abbreviations: COPD, chronic obstructive pulmonary disease; CI, confidence interval; N/S, not significant.

Table 5 Comprehension: overall improvement in understanding pulmonary rehabilitation procedures and steps to manage COPD, from baseline assessment to 3 months postintervention

Outcomes of interest (comparison of baseline assessment and 3-month postintervention assessment)	Mean difference from reference (95% CI)	t-statistic	Degrees of freedom	P-value
1. Understanding pulmonary rehabilitation procedures	Overall improvement from baseline assessment to 3 months postintervention
Group 1 compared to Group 4	2.14 (0.73, 3.16)	2.05	1.82	<0.05
Group 2 compared to Group 4	2.22 (0.86, 3.30)	2.24	1.82	<0.05
Group 3 compared to Group 4	0.30 (−0.76, 1.36)	1.72	1.82	N/S
Age (≤75 vs ≥76 years)	0.81 (0.22, 1.41)	2.75	1.82	<0.01
Education (low vs high)	−0.65 (−1.32, –0.02)	−2.53	1.82	<0.05
Sex (male vs female)	−0.18 (−0.84, 0.48)	−0.46	1.82	N/S
Disease severity	−0.60 (−2.11, 0.91)	1.11	1.82	N/S
2. Understanding steps to manage COPDa	Overall improvement from baseline assessment to 3 months postintervention
Group 1 compared to Group 4	0.08 (−0.94, 0.79)	0.42	1.82	N/S
Group 2 compared to Group 4	0.02 (−0.87, 0.92)	0.59	1.82	N/S
Group 3 compared to Group 4	0.29 (−0.62, 1.20)	0.23	1.82	N/S
Education (low vs high)	−0.10 (−0.69, 0.49)	−0.66	1.82	N/S
Sex (male vs female)	0.08 (−0.34, 0.51)	0.39	1.82	N/S
Age (≤75 vs ≥76 years)	0.30 (−0.09, 0.68)	1.45	1.82	N/S
Disease severity	0.10 (−0.88, 1.07)	1.69	1.82	N/S

Note:

a Understanding steps improved significantly from pretest to 3-month postintervention follow-up at P<0.05.

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; N/S, not significant.