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

Figures & data

Figure 1 Flowchart of program development.

Table 1 Participant demographics (n=14)

	Number (% of total)
Gender
Female	14 (100)
Ethnicity
White British	12 (85.7)
African Caribbean	1 (7.1)
Missing information	1 (7.1)
Profession
Physiotherapist	3 (21.4)
Respiratory research nurse	3 (21.4)
Practice nurse	3 (21.4)
Community respiratory nurse	2 (14.3)
Respiratory nurse	1 (7.1)
Nurse practitioner	1 (7.1)
Occupational therapist	1 (7.1)
Grade
Specialized	8 (57.1)
Highly specialized	5 (35.7)
Missing information	1 (7.1)
Mean years NHS experience (SD)	18.88 (10.31)
Mean years respiratory care experience (SD)	7.53 (5.31)

Abbreviations: NHS, National Health Service; SD, standard deviation.

Table 2 Key theme 1 – educational needs and training topics, exemplar quotations

Master theme	Subtheme	Example
COPD-specific knowledge	Anatomy and physiology	“If you were running this for people who’d never been involved in patients with COPD you’d have to have longer than a day to teach them about the disease” [Occupational therapist, secondary care]
	Exacerbations and disease progression	“Thinking about advanced disease […] that’s quite a shock and I don’t think we’re confident to discuss that with them” [Physiotherapist, secondary care]
	Exercise	“I’m not an expert in exercising or anything like that so all of it really is stuff that I could probably do with a bit more in depth information on” [Respiratory nurse, secondary care]
	Sex and relationships	“I think the area on relationships and talking about sex is [something] that a lot of people don’t cover and feel uncomfortable covering” [Nurse practitioner, primary care]
	Diet and eating	“I wouldn’t be brilliant at food, trying to get patients to eat a nice healthy diet” [Respiratory nurse, secondary care]
	Breathing and inhaler techniques	“It’s always good just to go over [inhaler techniques] with you to make sure you are right because things change and these are the sort of things you need to pass on to your patients” [Respiratory nurse, secondary care]
	Oxygen and traveling	“People ask about taking oxygen on holiday and that’s normally something I have to go off and find out rather than just having the knowledge there” [Physiotherapist, secondary care]
	Awareness of resources	“I never really know what’s out there for them [carers for people with COPD]” [Community respiratory nurse]
Delivery of manual	How to follow stages	“What I would want to know is do they have to follow stage one, two, three and four or can they do stage one, look at stage three – can it be flexible?” [Respiratory nurse, secondary care]
	Action plan	“The bit that I would want to see quite a lot more on is definitely the action plan, and about doing an action plan with the patient” [Nurse, secondary care]
Outcome measures	Administration	“[With] the outcome measures, if you’ve not been involved in rehabilitation the chances are you won’t be familiar with how you do [them]” [Physiotherapist, secondary care]
	Interpretation	“What would I be looking for to show that there had been a change? It’s just not something that we’d do” [Respiratory nurse, secondary care]
Communication skills	Confidence to listen	“You need to be able to listen to the patient about what they want” [Occupational therapist, secondary care]
	Imparting information	“A lot of the ideas that are second nature to you are absolutely brand new to patients” [Respiratory nurse, secondary care]
	Appropriate language	“A lot of the terminology that is second nature to you is absolutely brand new to patients” [Nurse practitioner, primary care]
	Dealing with difficult emotions	“I get a lot of anger from people who did give up smoking but […] five years down the line after quitting smoking they’ve still got a diagnosis of COPD and they didn’t realise that that was a potential issue” [Respiratory nurse, secondary care]

Table 3 Key theme 2 – preferred methods of training delivery, exemplar quotations

Master theme	Subtheme	Example
Face-to-face training	Opportunity to ask questions	“A study day run by health care professionals who work in this area would be beneficial and then people can ask questions” [Occupational therapist, secondary care]
	Practice manual delivery	“I’d like to work through it with someone that had been involved in setting it up and knew what they actually are looking for” [Respiratory nurse, secondary care]
	Manual delivery demonstrations	“A DVD would be a simple way you could do a team teaching session, stick the DVD in and watch it” [Physiotherapist, secondary care]
	Demonstrate exercise section	“Particularly [for] the exercise part you need a hands on, demonstrated part rather than just sitting and talking about it” [Respiratory nurse, secondary care]
	Observe motivational process	“I’d love to see [the manual] in action and how [the health care professional] talks to the patients and motivates them” [Respiratory nurse, secondary care]
	Group interaction	“When you actually get together […] you’ll bounce off each other’s ideas […] sometimes the most simplest ideas come out of group discussions” [Occupational therapist, secondary care]
Self-study	Manual familiarization	“I would really need to spend a lot of time looking through it myself and getting to know it” [Community respiratory nurse, primary care]
	Independent study	“Blood gases and patients retaining things and being hypoxic […] I think on those more medical things I need to brush up on” [Occupational therapist, secondary care]
Observations	Allied COPD services	“I keep meaning to go and visit the pulmonary rehab, I’ve been years ago and I’ve seen what I can remember of what goes on there, but it wouldn’t hurt to go again and just update […] and any ideas that I can pick up on that they can give me” [Community respiratory nurse]
E-Learning	Accessibility	“Face-to-face training might be difficult, I think e-learning might be an idea as you can access it from anywhere as long as you have a computer” [Physiotherapist, secondary care]
	Demonstrate understanding	“You could be assessed as to whether you’ve got the right amount of knowledge” [Research physiotherapist]
	Engagement with material	“I find it very easy to switch off when I am trying to do e-learning” [Respiratory research nurse, secondary care]

Table 4 Key theme 3 – posttraining support needs

Master theme	Subtheme	Example
Undertaking assessment of competence	Observations	“It’d be quite useful to know that you were going about working with [the manual] in the right way but I can’t think of how you would assess that other than having someone watch you with a patient and then give you feedback on it” [Physiotherapist, secondary care]
	Face-to-face reviews	“[We need] a month’s review to see how we’re getting on with using [the manual] and then whether we need any further training from that” [Physiotherapist, secondary care]
Follow-up support	Group sessions	“They’re usually done in small groups, the diabetes ones are, and it would be good to do the same for COPD, just small groups” [Practice nurse]
	Updates	“If there’s any changes, any updates, anything new that’s happening, that would be quite good online […] just to keep informed of what’s going on really in the service” [Community respiratory nurse]
	Expert advice	“I think you’d need […] a person that you can contact if you’re struggling with any component of the manual once you’re out there running it yourself” [Research physiotherapist]

Table 5 Key theme 4 – challenges to the process

Master theme	Sub-theme	Example
Challenges to health care professional training	Cost	“If the training course was very expensive then trying to justify it would be more difficult” [Physiotherapist, secondary care]
	Time	“I think that the pressures we have now to [prove] what we are doing clinically, to actually be taking more time out of work would be frowned upon” [Respiratory nurse, secondary care]
	Location	“I suppose it’s location isn’t it, I suppose if you were delivering a thing in Coventry it’s when’s a good time, are you going to do it in the day and people get time off work to come” [Physiotherapist, secondary care]
Challenges to delivery of SPACE for COPD manual	Time	“You are on a time limit as well, you’ve got to watch your timing” [Practice nurse]
	Contact with patients	“Actually I’d like to see you [the patient] four more times to talk through how you can manage yourself better and realising that actually the patient may not have the time or the inclination to come in and have all those extra appointments” [Community respiratory nurse]
	Cost of manual	“You might be presented with this beautiful book, which I don’t know how much it costs, but I wouldn’t imagine it’s that cheap to put out, so we could be wasting money for it just to prop up the coffee table or whatever” [Physiotherapist, secondary care]
	Size of manual	“It would look a bit overwhelming although just because of its size I think” [Community respiratory nurse]
	Follow-up assessments	“If we work through a particular section […] and make a note of that […] and then come back and see if they’ve got any improvements” [Practice nurse]
	Identify suitable patients	“This age group there might be elements of dementia creeping in” [Community respiratory nurse]

Abbreviation: SPACE, Self-Management Programme of Activity, Coping and Education.