Early Frances, Young Jane S, Robinshaw Elizabeth, Mi Emma Z, Mi Ella Z, Fuld Jonathan P
Centre for Self Management Support, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Faculty of Health, Social Care and Education, School of Nursing and Midwifery, Anglia Ruskin University, Cambridge, UK.
Int J Chron Obstruct Pulmon Dis. 2017 Oct 9;12:2955-2967. doi: 10.2147/COPD.S139532. eCollection 2017.
COPD has significant psychosocial impact. Self-management support improves quality of life, but programs are not universally available. IT-based self-management interventions can provide home-based support, but have mixed results. We conducted a case series of an off-the-shelf Internet-based health-promotion program, The Preventive Plan (TPP), coupled with nurse-coach support, which aimed to increase patient activation and provide self-management benefits.
A total of 19 COPD patients were recruited, and 14 completed 3-month follow-up in two groups: groups 1 and 2 with more and less advanced COPD, respectively. Change in patient activation was determined with paired -tests and Wilcoxon signed-rank tests. Benefits and user experience were explored in semistructured interviews, analyzed thematically.
Only group 1 improved significantly in activation, from a lower baseline than group 2; group 1 also improved significantly in mastery and anxiety. Both groups felt significantly more informed about COPD and reported physical functioning improvements. Group 1 reported improvements in mood and confidence. Overall, group 2 reported fewer benefits than group 1. Both groups valued nurse-coach support; for group 1, it was more important than TPP in building confidence to self-manage. The design of TPP and lack of motivation to use IT were barriers to use, but disease severity and poor IT skills were not.
Our findings demonstrate the feasibility of combining nurse-coach support aligned to an Internet-based health resource, TPP, in COPD and provide learning about the challenges of such an approach and the importance of the nurse-coach role.
慢性阻塞性肺疾病（COPD）具有重大的社会心理影响。自我管理支持可改善生活质量，但相关项目并非普遍可得。基于信息技术的自我管理干预措施可提供居家支持，但其效果不一。我们开展了一系列病例研究，采用一款现成的基于互联网的健康促进项目——预防计划（TPP），并辅以护士指导支持，旨在提高患者的积极性并提供自我管理益处。
共招募了19名COPD患者，其中14名完成了为期3个月的随访，分为两组：第1组和第2组分别为COPD病情程度较高和较低的患者。采用配对t检验和Wilcoxon符号秩检验来确定患者积极性的变化。通过半结构化访谈探讨益处和用户体验，并进行主题分析。
只有第1组的积极性显著提高，其基线水平低于第2组；第1组在掌握程度和焦虑方面也有显著改善。两组患者对COPD的了解都显著增加，并报告身体功能有所改善。第1组报告情绪和自信心有所改善。总体而言，第2组报告的益处少于第1组。两组患者都重视护士指导支持；对于第1组来说，在建立自我管理信心方面，护士指导支持比TPP更重要。TPP的设计和使用信息技术的积极性不足是使用的障碍，但疾病严重程度和信息技术技能差并非障碍。
我们的研究结果表明，在COPD患者中，将护士指导支持与基于互联网的健康资源TPP相结合是可行的，并提供了关于这种方法面临的挑战以及护士指导作用重要性的经验教训。
