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      How do informal self-care strategies evolve among patients with chronic obstructive pulmonary disease managed in primary care? A qualitative study

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          There is much description in the literature of how patients with chronic obstructive pulmonary disease (COPD) manage their breathlessness and engage in self-care activities; however, little of this is from the perspective of those with less severe disease, who are primarily managed in primary care. This study aimed to understand the self-care experiences of patients with COPD who are primarily managed in primary care, and to examine the challenges of engaging in such behaviors.


          Semistructured interviews were carried out with 15 patients with COPD as part of a larger project evaluating a self-management intervention. Thematic analysis was supported by NVivo software (version 8, QSR International, Melbourne, Australia).


          Three main themes are described, ie, experiencing and understanding symptoms of COPD, current self-care activities, and the importance of family perceptions in managing COPD.


          Self-care activities evolved spontaneously as participants experienced symptoms of COPD. However, there was a lack of awareness about whether these strategies would impact upon symptoms. Perceptions of COPD by family members posed a challenge to self-care for some participants. Health care professionals should elicit patients’ prior disease experiences and utilize spontaneous attempts at disease management in future self-management. These findings have implications for promoting self-management and enhancing quality of life.

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          Most cited references 17

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          Self-management education: history, definition, outcomes, and mechanisms.

          Self-management has become a popular term for behavioral interventions as well as for healthful behaviors. This is especially true for the management of chronic conditions. This article offers a short history of self-management. It presents three self-management tasks--medical management, role management, and emotional management--and six self-management skills--problem solving, decision making, resource utilization, the formation of a patient-provider partnership, action planning, and self-tailoring. In addition, the article presents evidence of the effectiveness of self-management interventions and posits a possible mechanism, self-efficacy, through which these interventions work. In conclusion the article discusses problems and solutions for integrating self-management education into the mainstream health care systems.
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            The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population.

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              Chronic illness self-management: taking action to create order.

              This paper presents research that was framed by our early understandings about the ways that people incorporate the consequences of illness into their lives. The word 'transition' has been used to describe this process. We believed self-management to be central to the transition process but this assertion required further research, hence this paper. The research aimed at understanding the way in which people who lived with chronic illness constructed the notion of self-management. While the participants of this study were living with arthritis, the focus was on understanding the meaning of self-management rather than the experience of living with the symptoms of arthritis. Data were generated when nine people living with arthritis were invited to write an autobiography about their life and experiences of living with illness. Two telephone interviews were recorded with each participant and then the research group (researchers and participants) convened for a discussion meeting. In contrast to health professionals who identify self-management as structured education, participants identified self-management as a process initiated to bring about order in their lives. Creating a sense of order, or self-management, had four key themes (i) Recognizing and monitoring the boundaries, (ii) Mobilizing the resources, (iii) Managing the shift in self-identity, (iv) Balancing, pacing, planning and prioritizing People learned about their responses to illness through daily life experiences and as a result of trial and error. They reconfigured their daily lives and reconstructed their self-identity by exploring their personal limitations or boundaries. Self-management of chronic illness has been considered as both structure and process, however it is the process of self-management that we contend is central to the experience of transition. Clinical nursing intervention for people with a long term illness may be enhanced when self-management is approached from a broad, contextual perspective and self-management processes are integrated into clinical practice. The challenge is for nurses to embrace processes in nursing practice that will facilitate interactions with clients without obstructing the diversity of perspectives, create an environment conducive to learning and engage individuals in identifying self-management strategies that have meaning in their lives.

                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                26 February 2014
                : 9
                : 257-263
                [1 ]National Institute of Health Research CLAHRC-LNR Pulmonary Rehabilitation Research Group, University Hospitals of Leicester NHS Trust, UK
                [2 ]School of Applied Social Sciences, De Montfort University, Leicester, UK
                [3 ]Applied Research Centre Health & Lifestyle Interventions, Coventry University, Coventry, UK
                Author notes
                Correspondence: Lindsay D Apps, Pulmonary Rehabilitation, University Hospitals of Leicester NHS Trust, Groby Road, Leicester, LE3 9QP, UK, Tel +44 011 6258 3181, Email lindsay.d.apps@
                © 2014 Apps et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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