Describing knowledge encounters in healthcare: a mixed studies systematic review and development of a classification

This review was self-funded

Effects of a COPD self-management support intervention: a randomized controlled trial

Heidi B Bringsvor,1,2 Eva Langeland,3 Bjørg Frøysland Oftedal,2 Knut Skaug,1 Jörg Assmus,4 Signe Berit Bentsen5 1Department of Research and Innovation, Helse Fonna HF, Haugesund, Norway; 2Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; 3Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway; 4Center for Clinical Research, Department of Reserach and Innovation, Haukeland University Hospital, Bergen, Norway; 5SHARE-Centre for Resilience in Health Care, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway Background: This study examines the effects of the COPD-specific health promoting self-management intervention “Better living with COPD” on different self-management-related domains, self-efficacy, and sense of coherence (SOC). Methods: In a randomized controlled design, 182 people with COPD were allocated to either an intervention group (offered Better living with COPD in addition to usual care) or a control group (usual care). Self-management-related domains were measured by the Health Education Impact Questionnaire (heiQ) before and after intervention. Self-efficacy was measured by the General Self-Efficacy Scale (GSE) and SOC was measured by the 13-item Sense of Coherence Scale (SOC-13). Effects were assessed by ANCOVA, using intention-to-treat (ITT) analysis and per-protocol analysis (PPA). Results: The PPA and the ITT analysis showed significant positive changes on Constructive attitudes and approaches (heiQ) (ITT: P=0.0069; PPA: P=0.0021) and Skill and technique acquisition (heiQ) (ITT: P=0.0405; PPA: P=0.0356). Self-monitoring and insight (heiQ) showed significant positive change in the PPA (P=0.0494). No significant changes were found on the other self-management domains (heiQ), self-efficacy (GSE), or SOC (SOC-13). Conclusion: Better living with COPD had a significant positive short-term effect on some self-management-related domains, and could be an intervention contributing to the support of self-management in people with COPD. However, further work is needed to establish the clinical relevance of the findings and to evaluate the long-term effects. Keywords: constructive attitudes and approaches, Health Education Impact Questionnaire (heiQ), self-efficacy, self-monitoring and insight, sense of coherence, skill and technique acquisitio

Symptom burden and self-management in persons with chronic obstructive pulmonary disease

Heidi B Bringsvor,1,2 Knut Skaug,1 Eva Langeland,3 Bjørg Frøysland Oftedal,2 Jörg Assmus,4 Doris Gundersen,1 Richard H Osborne,5 Signe Berit Bentsen2 1Department of Research and Innovation, Helse Fonna HF, Haugesund, 2Department of Quality and Health Technology, University of Stavanger, Stavanger, 3Department of Nursing, Western Norway University of Applied Sciences, 4Center for Clinical Research, Haukeland University Hospital, Bergen, Norway; 5Health Systems Improvement Unit, School of Health and Social Development, Centre For Population Health Research, Deakin University, Burwood, Victoria, Australia Purpose: Self-management is crucial for effective COPD management. This study aimed at identifying associations between self-management and sociodemographic characteristics, clinical characteristics, and symptom burden in people with COPD. Patients and methods: In this cross-sectional study with 225 participants diagnosed with COPD grades II–IV, multiple linear regression analysis was conducted, using sociodemographic and clinical characteristics and symptom burden (COPD Assessment Test) as the independent variables and the eight self-management domains of the Health Education Impact Questionnaire (heiQ) as the outcome variables. Results: Higher symptom burden was significantly associated with worse scores in all self-management domains (p<0.003), except for self-monitoring and insight (p=0.012). Higher disease severity (p=0.004) and numbers of comorbidities (p<0.001) were associated with more emotional distress, and women scored higher than men on positive and active engagement in life (p=0.001). Higher score in pack-years smoking was associated with lower score in health-directed activities (p=0.006) and self-monitoring and insight (p<0.001), and participation in organized physical training was associated with higher score in health-directed activities (p<0.001). The final models explained 3.7%–31.7% of variance (adjusted R2) across the eight heiQ scales. Conclusion: A notable finding of this study was that higher symptom burden was associated with worse scores in all self-management domains, except for self-monitoring and insight. In addition, sex, disease severity, comorbidity, pack-years smoking, and participation in organized physical training were associated with one or two self-management domains. The study contributes to improved understanding of self-management in COPD. However, the explained variance levels indicate that more research needs to be done to uncover what else explains self-management domains in COPD. Keywords: COPD, Health Education Impact Questionnaire, COPD Assessment Test, self-management, symptoms, chronic diseas