title: Determinants of activation for self-management in patients with COPD.
abstract: BACKGROUND
  COPD self-management is a complex behavior influenced by many factors. Despite scientific evidence that better disease outcomes can be achieved by enhancing self-management, many COPD patients do not respond to self-management interventions. To move toward more effective self-management interventions, knowledge of characteristics associated with activation for self-management is needed. The purpose of this study was to identify key patient and disease characteristics of activation for self-management.
  
  
  METHODS
  An explorative cross-sectional study was conducted in primary and secondary care in patients with COPD. Data were collected through questionnaires and chart reviews. The main outcome was activation for self-management, measured with the 13-item Patient Activation Measure (PAM). Independent variables were sociodemographic variables, self-reported health status, depression, anxiety, illness perception, social support, disease severity, and comorbidities.
  
  
  RESULTS
  A total of 290 participants (age: 67.2±10.3; forced expiratory volume in 1 second predicted: 63.6±19.2) were eligible for analysis. While poor activation for self-management (PAM-1) was observed in 23% of the participants, only 15% was activated for self-management (PAM-4). Multiple linear regression analysis revealed six explanatory determinants of activation for self-management (P<0.2): anxiety (β: -0.35; -0.6 to -0.1), illness perception (β: -0.2; -0.3 to -0.1), body mass index (BMI) (β: -0.4; -0.7 to -0.2), age (β: -0.1; -0.3 to -0.01), Global Initiative for Chronic Obstructive Lung Disease stage (2 vs 1 β: -3.2; -5.8 to -0.5; 3 vs 1 β: -3.4; -7.1 to 0.3), and comorbidities (β: 0.8; -0.2 to 1.8), explaining 17% of the variance.
  
  
  CONCLUSIONS
  This study showed that only a minority of COPD patients is activated for self-management. Although only a limited part of the variance could be explained, anxiety, illness perception, BMI, age, disease severity, and comorbidities were identified as key determinants of activation for self-management. This knowledge enables health care professionals to identify patients at risk of inadequate self-management, which is essential to move toward targeting and tailoring of self-management interventions. Future studies are needed to understand the complex causal mechanisms toward change in self-management.
authors.affiliation: Research Group Chronic Illnesses, Faculty of Health Care, University of Applied Sciences Utrecht; Department of Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht; Department of Respiratory Medicine, Division of Heart & Lungs, University Medical Center Utrecht.
authors.forename: Yjg
authors.initials: Y
authors.lastname: Korpershoek
authors.affiliation: Department of Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht.
authors.forename: I D
authors.initials: ID
authors.lastname: Bos-Touwen
authors.affiliation: Department of Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht; Nursing Science, Program in Clinical Health Science, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: de Man-van Ginkel
authors.affiliation: Department of Respiratory Medicine, Division of Heart & Lungs, University Medical Center Utrecht.
authors.forename: J-Wj
authors.initials: JW
authors.lastname: Lammers
authors.affiliation: Research Group Chronic Illnesses, Faculty of Health Care, University of Applied Sciences Utrecht; Department of Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht.
authors.forename: M J
authors.initials: MJ
authors.lastname: Schuurmans
authors.affiliation: Department of Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht.
authors.forename: Jca
authors.initials: J
authors.lastname: Trappenburg
mesh_terms: D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D005260:Female; D005541:Forced Expiratory Volume; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006801:Humans; D016014:Linear Models; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010465:Perception; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D012307:Risk Factors; D063127:Secondary Health Care; D012648:Self Care; D057566:Self Report; D012720:Severity of Illness Index; D012944:Social Support
keywords: COPD; patient activation; patient and disease characteristics; self-management