Date of Award

August 2018

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Nursing

First Advisor

Rachel F Schiffman

Second Advisor

Jeanne Erickson

Committee Members

James D Topitzes, Julie L Ellis

Keywords

chronic illness, chronic obstructive pulmonary disease, health care, qualitative, self-management

Abstract

Chronic Obstructive Pulmonary Disease (COPD) is an incurable lung illness causing significant individual and public health burden. Individuals with COPD often experience high symptom burden, unpredictable exacerbations, numerous comorbid conditions, and frequent health care utilization. Self-management can improve health outcomes and reduce health care costs; however, many individuals with COPD struggle with effective self-management. Improving the self-management of individuals with COPD and the delivery of self-management support from health care providers is crucial to reducing the individual and societal costs of the illness.

The purpose of this study was to explore the self-management experiences of community-dwelling adults living with COPD with an emphasis on understanding the daily challenges they face, their response to these challenges, and their experiences when seeking health care. This qualitative study informed by the Individual and Family Self-Management Theory (IFSMT) used one-time, in-depth interviews to explore the experiences of 28 men and women living with COPD.

Thematic analysis resulted in the identification of eight themes: 1) accepting the disease; 2) maintaining function; 3) paying for it; 4) dealing with triggers; 5) getting through exacerbations; 6) getting information; 7) feeling rushed and; 8) not feeling heard. Three additional sub-themes related to maintaining function were also identified: 1) staying active; 2) preventing infections; and 3) medicating or not. Results of the analysis were mapped to the IFSMT.

The results of this study offer new insights regarding the contextual and process factors impacting self-management behaviors. Specifically, the impact of financial resources on medication management behaviors and the self-regulatory processes related to disease acceptance, environmental triggers, and patient-reported cough syncope were described. Descriptions of self-management support were also identified from participants’ accounts of their COPD-related health care encounters. These findings have implications for informing evidence-based recommendations and improving the quality of care for people living with COPD. Future research is indicated to further explore the impact of these context and process variables on self-management behaviors and to test the findings of this study as mapped to the

IFSMT to expand theoretical and conceptual understanding.

Available for download on Friday, August 28, 2020

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