Factors Associated with Non-Adherence to Self-Management Among Patients with Chronic Obstructive Pulmonary Disease: A Survey Using the Delphi Technique and Analytic Hierarchy Process

Figures & data

Table 1 Factors Associated with Non-Adherence to COPD Self-Management in the Delphi Survey (N = 15)

Factor	Second Round			Third Round
	Mean ± SD	CVR	Priority	Mean ± SD	CVR	Priority
Smoking status	4.47±0.52	1.00	1	4.47±0.52	1.00	1
Economic status	4.27±0.59	0.87	4	4.33±0.49	1.00	1
Social support	4.33±0.62	0.87	4	4.33±0.49	1.00	1
Severity of COPD	4.47±0.64	0.87	4	4.60±0.51	1.00	1
Acute exacerbation experience	4.53±0.52	1.00	1	4.73±0.46	1.00	1
Experience of medication side effects	4.20±0.41	1.00	1	4.13±0.35	1.00	1
Education level	4.07±0.96	0.73	7	4.33±0.62	0.87	7
Social recognition of COPD	4.20±0.77	0.73	7	4.20±0.56	0.87	7
Frequency of symptoms	4.40±0.74	0.73	7	4.53±0.64	0.87	7
Activities of daily living	4.07±0.70	0.60	10	3.53±0.99	0.87	7
Unknown effects of medication	3.93±0.59	0.60	10	4.00±0.38	0.87	7
Professionalism of healthcare providers	3.73±1.03	0.60	10	3.87±0.52	0.87	7
Number of medications	4.00±0.85	0.60	10	3.67±0.82	0.87	7
Age	4.07±0.80	0.47	19	3.87±0.74	0.73	14
Disease duration	4.20±0.77	0.60	10	4.27±0.70	0.73	14
Possibility of recovery from COPD	4.07±0.88	0.60	10	4.20±0.86	0.73	14
Complexity of symptoms	4.07±0.80	0.47	19	4.20±0.68	0.73	14
Comorbidity	3.93±0.80	0.60	10	3.93±0.70	0.73	14
Quality of life	3.93±0.59	0.60	10	3.93±0.50	0.73	14
COPD knowledge	3.93±0.88	0.47	19	3.73±0.59	0.73	14
Prolonged treatment	3.80±0.68	0.60	10	4.20±0.68	0.60	21
Time to symptom relief	3.80±0.77	0.47	19	3.80±0.41	0.60	21
Medical cost	3.93±0.70	0.47	19	3.80±0.56	0.47	23
Emotional state	3.80±1.01	0.33	27	3.87±0.99	0.47	23
Beliefs about medicines	3.80±0.86	0.33	27	3.80±0.77	0.47	23
Treatment beliefs	3.87±0.83	0.47	19	3.80±0.77	0.47	23
Trust in healthcare providers	3.73±0.96	0.33	27	3.80±0.94	0.47	23
Physical activity	3.87±0.83	0.47	19	3.73±0.80	0.47	23
Complexity of treatment	3.67±0.98	0.47	19	3.73±0.70	0.47	23
COPD incidence rate	3.87±1.13	0.20	31	4.00±1.00	0.33	30
Motivation	4.00±1.07	0.20	31	4.00±1.00	0.33	30
Forgetfulness	3.47±1.13	0.20	31	3.80±0.41	0.33	30
Health literacy	3.67±0.98	0.20	31	4.20±0.56	0.33	30
Routine pulmonary rehabilitation	3.73±0.70	0.20	31	3.87±0.83	0.33	30
Experience of treatment failure	3.40±0.99	0.20	31	3.53±0.74	0.33	30
Living environment	3.73±0.59	0.33	27	3.73±0.59	0.33	30
Partnership between patients and healthcare providers	3.47±0.64	0.07	38	3.53±0.64	0.20	37
Access to medical resources	3.73±0.88	0.20	31	3.60±0.83	0.20	37
Self-efficacy	3.47±1.25	0.07	38	3.60±1.06	0.07	39
Hospital-community links	3.67±0.90	0.07	38	3.20±0.77	0.07	39
Self-management program	3.47±0.99	−0.20	43	3.40±0.83	−0.07	41
Waiting time for consultation	3.47±0.74	−0.07	42	4.27±0.59	−0.07	41
Medically-oriented care	3.53±0.92	0.07	38	3.47±0.74	−0.07	41
Occupation	3.13±1.06	−0.20	43	3.27±0.88	−0.20	44
Consultation time	3.13±0.92	−0.20	43	2.67±0.82	−0.20	44
Support of COPD	3.13±0.83	−0.20	43	3.07±0.88	−0.20	44
Social activity	3.20±0.77	−0.20	43	3.20±0.68	−0.33	47
Gender	2.93±1.22	−0.33	48	2.8±0.86	−0.47	48
Personality	2.93±1.16	−0.33	48	2.87±0.92	−0.47	48
Surroundings	3.07±1.03	−0.47	50	2.93±0.88	−0.60	50
Treatment system	2.60±0.83	−0.87	52	3.40±0.83	−0.87	51
Religion	1.93±1.03	−0.87	52	1.73±0.70	−1.00	52
Weather	2.47±1.06	−0.73	51	2.13±0.83	−1.00	52

Abbreviations: COPD, chronic obstructive pulmonary disease; CVR, content validity ratio; SD, standard deviation.

Table 2 Complex Judgment Matrix of Pairwise Comparison Matrices in the Analytic Hierarchy Process (N = 15)

	Personal Characteristics	Socioeconomic Characteristics	Disease-Related Characteristics	Psychological Characteristics	Functional Characteristics	Treatment-related Characteristics	Healthcare System-Related Characteristics	Environmental Characteristics
Personal characteristics	1
Socioeconomic characteristics	0.57	1
Disease-related characteristics	0.36	0.41	1
Psychological characteristics	0.55	0.69	1.17	1.00
Functional characteristics	0.43	0.54	1.35	0.92	1.00
Treatment-related characteristics	0.34	0.44	0.76	0.66	0.63	1.00
Healthcare system-related characteristics	0.75	0.79	1.18	0.89	1.16	1.96	1.00
Environmental characteristics	0.95	1.47	2.64	2.07	2.12	4.02	1.81	1.00

Table 3 Factors Associated with Non-Adherence to COPD Self-Management in the Analytic Hierarchy Process (N = 15)

Factor Category	Weight (W)	Priority	Consistency Ratio (CR)*	Factor	Within Category		Within Factor
					Weight (W)	Priority	Weight (W%)	Priority
Treatment-related characteristics	0.22	1	0.006	Prolonged treatment	0.04	1	3.46	2
				Experience of treatment failure	0.03	2	3.05	3
				Unknown effects of medication	0.03	2	3.02	4
				Experience of medication side effects	0.03	2	2.55	10
				Self-management program	0.03	2	2.48	13
				Time to symptom relief	0.02	6	2.17	18
				Complexity of treatment	0.02	6	1.98	20
				Number of medication	0.02	6	1.84	24
				Professionalism of healthcare providers	0.01	9	1.27	42
Disease-related characteristics	0.17	2	0.007	Acute exacerbation experience	0.04	1	4.16	1
				Severity of COPD	0.03	2	3.00	5
				Possibility of recovery from COPD	0.02	3	2.13	19
				Complexity of symptoms	0.02	3	1.94	22
				COPD incidence rate	0.02	3	1.64	27
				Comorbidity	0.02	3	1.62	29
				Frequency of symptoms	0.02	3	1.52	34
				Disease duration	0.01	8	1.27	42
Functional characteristics	0.14	3	0.003	Routine pulmonary rehabilitation	0.03	1	2.73	7
				Physical activity	0.03	1	2.61	9
				Health literacy	0.03	1	2.55	10
				COPD knowledge	0.03	1	2.54	12
				Activities of daily living	0.02	5	2.20	17
				Forgetfulness	0.02	5	1.56	33
Psychological characteristics	0.13	4	0.004	Self-efficacy	0.02	1	1.85	23
				Beliefs about medicines	0.02	1	1.84	24
				Quality of life	0.02	1	1.67	26
				Treatment beliefs	0.02	1	1.64	27
				Trust in healthcare providers	0.02	1	1.46	36
				Emotional state	0.01	6	1.07	46
				Confidence	0.01	6	1.04	47
				Personality	0.01	6	0.85	51
Healthcare system related characteristics	0.12	5	0.005	Support of COPD	0.02	1	1.96	21
				Medically oriented care	0.02	1	1.59	30
				Consultation time	0.02	1	1.58	31
				Treatment system	0.02	1	1.57	32
				Partnership between patients and healthcare providers	0.02	1	1.47	35
				Hospital-community links	0.02	1	1.46	36
				Access to medical resources	0.01	7	1.31	41
				Waiting time for consultation	0.01	7	0.99	49
Socioeconomic characteristics	0.1	6	0.002	Economic status	0.03	1	2.69	8
				Medical cost	0.02	2	2.41	14
				Social support	0.01	4	1.33	39
				Social recognition of COPD	0.01	4	1.33	39
				Social activity	0.01	4	1.25	44
Personal characteristics	0.07	7	0.011	Smoking status	0.02	1	2.29	15
				Education level	0.01	2	1.37	38
				Age	0.01	2	1.001	48
				Occupation	0.01	2	0.97	50
				Gender	0.01	2	0.64	52
				Religion	0.00	6	0.37	53
Environmental characteristics	0.06	8	0.002	Living environment	0.03	1	2.88	6
				Surroundings	0.02	2	2.21	16
				Weather	0.01	3	1.23	45

Note: *Consistency ratio for each factor ranges from 0.01 to 0.46.

Table 4 Priority of Relevant Factors Associated with Non-Adherence to COPD Self-Management in the Delphi Survey and Analytic Hierarchy Process (N =15)

Delphi Survey			Analytic Hierarchy Process
Factor	Third CVR	Priority	Factor	Weight (%)	Priority
Smoking status*	1.00	1	Acute exacerbation experience*	4.16	1
Acute exacerbation experience*	1.00	1	Prolonged treatment*	3.46	2
Prolonged treatment*	1.00	1	Experience of treatment failure*	3.05	3
Economic status*	1.00	1	Unknown effects of medication*	3.02	4
Social support	1.00	1	Severity of COPD*	3.00	5
Severity of COPD*	1.00	1	Living environment	2.88	6
Education level	0.87	7	Routine pulmonary rehabilitation	2.73	7
Social recognition of COPD	0.87	7	Economic status*	2.69	8
Frequency of symptoms	0.87	7	Physical activity	2.61	9
Activities of daily living*	0.87	7	Health literacy	2.55	10
Experience of treatment failure*	0.87	7	Experience of medication side effects*	2.55	10
Unknown effects of medication*	0.87	7	COPD knowledge*	2.54	12
Self-management program*	0.87	7	Self-management program*	2.48	13
Disease duration	0.73	14	Medical cost	2.41	14
Possibility of recovery from COPD*	0.73	14	Smoking status*	2.29	15
Comorbidity	0.73	14	Surroundings	2.21	16
Quality of life	0.73	14	Activities of daily living*	2.20	17
Age	0.73	14	Time to symptom relief*	2.17	18
Complexity of symptoms*	0.73	14	Possibility of recovery from COPD*	2.13	19
COPD knowledge*	0.73	14	Complexity of treatment	1.98	20
Time to symptom relief*	0.60	21	Support of COPD	1.96	21
Experience of medication side effects*	0.60	21	Complexity of symptoms*	1.94	22

Note: *Factors common to both the Delphi survey and analytic hierarchy process.

Abbreviations: COPD, chronic obstructive pulmonary disease; CVR, content validity ratio.