title: Factors influencing exacerbation-related self-management in patients with COPD: a qualitative study.
abstract: BACKGROUND
  In patients with COPD, self-management skills are important to reduce the impact of exacerbations. However, both detection and adequate response to exacerbations appear to be difficult for some patients. Little is known about the underlying process of exacerbation-related self-management. Therefore, the objective of this study was to identify and explain the underlying process of exacerbation-related self-management behavior.
  
  
  METHODS
  A qualitative study using semi-structured in-depth interviews was performed according to the grounded theory approach, following a cyclic process in which data collection and data analysis alternated. Fifteen patients (male n=8; age range 59-88 years) with mild to very severe COPD were recruited from primary and secondary care settings in the Netherlands, in 2015.
  
  
  RESULTS
  Several patterns in exacerbation-related self-management behavior were identified, and a conceptual model describing factors influencing exacerbation-related self-management was developed. Acceptance, knowledge, experiences with exacerbations, perceived severity of symptoms and social support were important factors influencing exacerbation-related self-management. Specific factors influencing recognition of exacerbations were heterogeneity of exacerbations and habituation to symptoms. Feelings of fear, perceived influence on exacerbation course, patient beliefs, ambivalence toward treatment, trust in health care providers and self-empowerment were identified as specific factors influencing self-management actions.
  
  
  CONCLUSIONS
  This study provided insight into factors influencing exacerbation-related self-management behavior in COPD patients. The conceptual model can be used as a framework for health care professionals providing self-management support. In the development of future self-management interventions, factors influencing the process of exacerbation-related self-management should be taken into account.
authors.affiliation: Research Group Chronic Illnesses, Faculty of Health Care, University of Applied Sciences Utrecht; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht.
authors.forename: Yjg
authors.initials: Y
authors.lastname: Korpershoek
authors.affiliation: Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Scjm
authors.initials: S
authors.lastname: Vervoort
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht.
authors.forename: Lit
authors.initials: L
authors.lastname: Nijssen
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht.
authors.forename: Jca
authors.initials: J
authors.lastname: Trappenburg
authors.affiliation: Research Group Chronic Illnesses, Faculty of Health Care, University of Applied Sciences Utrecht; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht.
authors.forename: M J
authors.initials: MJ
authors.lastname: Schuurmans
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D066296:Grounded Theory; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010465:Perception; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D036301:Qualitative Research; D021641:Recognition, Psychology; D012648:Self Care; D012649:Self Concept; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation; D000074606:Smoking Prevention; D012944:Social Support; D012959:Socioeconomic Factors; D016896:Treatment Outcome
keywords: COPD; exacerbation; grounded theory; qualitative research; self-management