Exploring patients with COPD self-care behaviours and self-efficacy and their interconnections: A network analysis.

ABSTRACT

AIM: The aim of this study was to investigate self-care behaviours of patients with chronic obstructive pulmonary disease (COPD), understand their complex interconnections and identify key behaviours influencing self-care and self-efficacy. DESIGN: An observational, cross-sectional study design. SETTING(S) The outpatient department of two tertiary hospital. METHODS: A convenience sample of patients with a diagnosis of COPD were included (n = 222). Self-care behaviours were assessed using the Chinese version of self-care of chronic obstructive pulmonary disease inventory based on the Middle-Range Theory of Self-Care of Chronic Illness. Patient self-care efficacy was evaluated using Chinese version of Self-Care Self-Efficacy Scale in Chronic Obstructive Pulmonary Disease. Employing network analysis, associations between behaviours (nodes) and their interrelationships (edges) were deciphered. The study was reported following the STROBE checklist. RESULTS: Among the spectrum of self-care behaviours, patients exhibited the most pronounced deficiencies in behaviours directed to enhancing breathing, monitoring extra-respiratory symptoms and problem-solving. Within the network, the most central emerging behaviour was the modification of prescribed therapy at the worsening of symptoms, as suggested by healthcare providers, which drives all self-care behaviours. The confidence in being able to do something to relieve symptoms, despite difficulties, was a bridging activator of self-care. The network structure underscored the prominence of self-care self-efficacy in driving self-care maintenance, monitoring, and management behaviours. CONCLUSIONS: Education programs for COPD should prioritise enhancing breathing, symptom monitoring and problem-solving skills. The crucial self-care behaviour in COPD involves adjusting treatments in response to symptom changes. Patient confidence in symptom alleviation acts as a catalyst for self-care engagement. Targeted assessments addressing these aspects could enhance educational interventions, ultimately improving COPD patient outcomes. REGISTRATION This study has been registered in the Chinese Clinical Trials Registry (registration number ChiCTR2200059764; registration date 11 May 2022).