Determinants of activation for self-management in patients with COPD

Figures & data

Table 1 Baseline characteristics of the study population

Sociodemographic characteristics	Total (n=290)
Sex
Male	184 (63.4%)
Female	105 (36.2%)
Age, years (mean ± SD)	67.2±10.3
BMI (mean ± SD)	26.6±4.7
Ethnicity
Dutch	268 (92.4%)
Other	19 (6.6%)
Marital statusa
Married	192 (66.2%)
Not married	98 (33.8%)
Living situation
Living alone	72 (24.8%)
Not living alone	213 (73.4%)
Education levelb
Low	126 (43.4%)
Medium	111 (38.3%)
High	46 (15.9%)
Current working
Yes	48 (16.6%)
No	237 (81.7%)
Financial distress
None	121 (41.7%)
Low	129 (44.5%)
High	33 (11.4%)
Care allowancec
Received	119 (41.0%)
Not received	159 (54.8%)
Smoking
Never	25 (8.6%)
Former	173 (59.7%)
Current	89 (30.7%)
Average smoking (pack-years) (mean ± SD)	36.6±24.6
Social support (MSPSS) (mean ± SD)	60.6±17.4
HADS
Depression (mean ± SD)	5.6±4.1
Anxiety (mean ± SD)	5.7±4.3
Health status (SF-12)
Physical component (mean ± SD)	45.6±24.5
Mental component (mean ± SD)	61.7±23.4
Illness perception (B-IPQ) (mean ± SD)	40.1±12.0
Activation (PAM) (mean ± SD)	54.7±10.4
Illness duration
≤2 years	42 (14.5%)
2–5 years	69 (23.8%)
>5 years	135 (46.6%)
FEV1% predicted (mean ± SD)	63.6±19.2
GOLD staged
I (mild)	93 (32.1%)
II (moderate)	133 (45.9%)
III (severe)	40 (13.8%)
IV (very severe)	14 (4.8%)
MRC score
≤3	183 (63.1%)
>3	105 (36.2%)
Charlson comorbidity index (mean ± SD)e	2.5±1.5
Current exacerbationf
No	224 (77.2%)
Yes	60 (20.7%)

Notes: Data are presented in n (%) unless specified otherwise.

a Marital status: married, widow, divorced, or unmarried people were included;

b education level: low (primary school through vocational training), medium (secondary school or vocational training), and high (college or university degree);

c care allowance received by single people making an annual living of <€30.939 or a combined annual living of <€42.438;

d GOLD stage: I (FEV₁ ≥80%), II (50%≤ FEV₁ <80%), III (30%≤ FEV₁ <50%), IV (FEV₁ <30%);

e comorbidities: cardiovascular diseases, respiratory diseases, diabetes, kidney diseases, liver diseases, cancer, connective tissue disorders, paraplegia, osteoporosis and arthrosis, gastrointestinal disorders, anxiety and depression, Parkinson’s disease and multiple sclerosis, eczema, dementia, and HIV;

f Current exacerbation: no (no course of antibiotics and/or prednisolone in the past 3 weeks), yes (course of antibiotics and/or prednisolone in the past 3 weeks).

Abbreviations: BMI, body mass index; FEV₁, forced expiratory volume in 1 second; MSPSS, Multidimensional Scale of Perceived Social Support; B-IPQ, Brief Illness Perception Questionnaire; PAM, Patient Activation Measure; SD, standard deviation; HADS, Hospital Anxiety and Depression Scale; GOLD, Global Initiative for Chronic Obstructive Lung Disease; MRC, Medical Research Council; SF-12, Short-Form-12 Health Survey.

Figure 1 Flowchart of recruitment.

Abbreviation: PAM, Patient Activation Measure.

Figure 2 Distribution of different PAM levels.

Notes: Level 1 (≤47.0): Disengaged and overwhelmed: Individuals are passive and lack confidence. Knowledge is low, goal-orientation is weak, and adherence is poor. Level 2 (47.1–55.1): Becoming aware, but still struggling: Individuals have some knowledge, but large gaps remain. They believe health is largely out of their control, but can get simple goals. Level 3 (55.2–67.0): Taking action: Individuals have the key facts and are building self-management skills. They strive for the best practice behaviors and are goal-oriented. Level 4 (≥67.1): Maintaining behaviors and pushing further: Individuals have adopted new behaviors, but may struggle in times of stress or change. Maintaining a healthy lifestyle is a key focus. Description of PAM levels is cited from http://www.insigniahealth.com.²³
Abbreviation: PAM, Patient Activation Measure.

Table 2 Univariate linear regression and multiple linear regression to analyze the association between multiple determinants and activation for self-management

Association of determinants with self-management capacity (PAM-13)	Univariate linear regression			Multiple linear regression
	β	95% CI	P-value	β	95% CI	P-value
Health status physical component (SF-12)	0.12	0.08/0.17	0.00		NA
Health status mental component (SF-12)	0.11	0.06/0.16	0.00		NA
Anxiety (HADS)	−0.54	−0.81/−0.27	0.00	−0.35	−0.64/−0.06	0.02
Depression (HADS)	−0.69	−0.97/−0.41	0.00		NA
Illness perception (B-IPQ)	−0.26	−0.36/−0.17	0.00	−0.17	−0.28/−0.06	0.00
Social support (MSPSS)	0.05	−0.01/0.12	0.12		NA
Age (years)	−0.11	−0.22/0.01	0.07	−0.14	−0.26/−0.01	0.03
Sex (female vs male)	0.25	−2.26/2.76	0.85		NA
BMI (kg/m^2)	−0.38	−0.64/−0.13	0.00	−0.42	−0.65/−0.19	0.00
Ethnicity (other vs Dutch)	−4.14	−8.96/0.69	0.09		NA
Living situation (not alone vs alone)	−1.27	−4.05/1.50	0.37		NA
Education level (low, medium, high)					NA
Moderate vs low	2.30	−0.32/4.92	0.09
High vs low	4.85	1.40/8.31	0.01
Financial distress (none, low, high)					NA
Low vs none	−0.91	−3.50/1.68	0.49
High vs none	−2.30	−6.32/1.71	0.26
Care allowance (received vs not received)	0.23	−2.25/2.71	0.86		NA
Current smoking (never, former, current)					NA
Former vs never	3.78	−0.56/8.13	0.09
Current vs never	3.98	−0.62/8.59	0.09
Dyspnea (MRC) (>3 vs ≤3)	−3.69	−6.17/−1.21	0.00		NA
GOLD stage
GOLD 2 vs 1	−3.65	−6.37/−0.93	0.01	−3.15	−5.77/−0.54	0.02
GOLD 3 vs 1	−4.89	−8.70/−1.08	0.01	−3.37	−7.07/0.32	0.07
GOLD 4 vs 1	−4.02	−9.70/1.67	0.17	−2.48	−7.62/2.67	0.35
Illness duration (≤2 years, 2–5 years, >5 years)					NA
2–5 years vs ≤2 years	1.25	−2.60/5.09	0.53
>5 years vs ≤2 years	−0.44	−4.07/3.20	0.81
Current exacerbation (no vs yes)	2.40	−0.56/5.35	0.11		NA
Comorbidity (CCI)	0.42	−0.38/1.21	0.30	0.79	−0.19/1.77	0.11
Explained variance of the model R^2=0.172 (n=290)

Abbreviations: MSPSS, Multidimensional Scale of Perceived Social Support; B-IPQ, Brief Illness Perception Questionnaire; PAM, Patient Activation Measure; HADS, Hospital Anxiety and Depression Scale; GOLD, Global Initiative for Chronic Obstructive Lung Disease; MRC, Medical Research Council; BMI, body mass index; CCI, Charlson comorbidity index; CI, confidence interval; NA, not applicable; SF-12, Short-Form-12 Health Survey.

Insignia HealthPatient Activation Measure (PAM) Survey levels Available from: http://www.insigniahealth.com/products/pam-surveyAccessed March 10, 2016

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