title: A motivational intervention for patients with COPD in primary care: qualitative evaluation of a new practitioner role.
abstract: BACKGROUND
  Long-term conditions such as chronic obstructive pulmonary disease (COPD) are growing challenges for health services. Psychosocial co-morbidity is associated with poorer quality of life and greater use of health care in these patients but is often un-diagnosed or inadequately treated in primary care, where most care for these patients is provided. We developed a brief intervention, delivered by 'liaison health workers' (LHWs), to address psychosocial needs in the context of an integrated approach to physical and mental health. We report a qualitative study in which we characterize the intervention through the experience of the patients receiving it and examine how it was incorporated into primary care.
  
  
  METHODS
  Qualitative study using patient and practice staff informants. We audio-recorded interviews with 29 patients offered the intervention (three had declined it or withdrawn) and 13 practice staff (GPs, nurses and administrators). Analysis used a constant comparative approach.
  
  
  RESULTS
  Most patients were enthusiastic about the LHWs, describing the intervention as mobilizing their motivation for self-management. By contrast with other practitioners, patients experienced the LHWs as addressing their needs holistically, being guided by patient needs rather than professional agendas, forming individual relationships with patients and investing in patients and their capacity to change. Practices accommodated and accepted the LHWs, but positioned them as peripheral to and separate from the priority of physical care.
  
  
  CONCLUSIONS
  Despite being a short-term intervention, patients described it as having enduring motivational benefits. The elements of the intervention that patients described map onto the key features of motivating interventions described by Self-Determination Theory. We suggest that the LHWs motivated patients to self-management by: (i) respecting patients' competence to decide on needs and priorities; (ii) forming relationships with patients as individuals; and (iii) fostering patients' sense of autonomy. While truly integrated primary care for patients with long-term conditions such as COPD remains elusive, existing practice staff might adopt elements of the LHWs' approach to enhance motivational change in patients with long-term conditions such as COPD.
authors.forename: Susanne
authors.initials: S
authors.lastname: Langer
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Chew-Graham
authors.forename: Jessica
authors.initials: J
authors.lastname: Drinkwater
authors.forename: Cara
authors.initials: C
authors.lastname: Afzal
authors.forename: Kim
authors.initials: K
authors.lastname: Keane
authors.forename: Cheryl
authors.initials: C
authors.lastname: Hunter
authors.forename: Else
authors.initials: E
authors.lastname: Guthrie
authors.affiliation: Department of Psychological Sciences, University of Liverpool, Liverpool L69 3GB, UK. psalmon@liv.ac.uk.
authors.forename: Peter
authors.initials: P
authors.lastname: Salmon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D024802:Nurse's Role; D017060:Patient Satisfaction; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000451:nursing* / Q000523:psychology; D036301:Qualitative Research; D011788:Quality of Life; D012648:Self Care