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Introduction: Hospital care is critical when assessing the overall quality of chronic obstructive pulmonary disease (COPD) care, particularly for people living with severe COPD who are frequently hospitalised due to exacerbations. The hospitalisation experience for people with COPD is often complex, involving various interactions and has been reported to be suboptimal. A comprehensive understanding of these experiences is lacking. With the intention of informing a holistic approach in COPD hospital care, this study aimed to explore the experiences and expectations of individuals with severe COPD regarding hospital care due to exacerbations of COPD.

Methods: Acknowledging the complexity of interactions within the studied scenarios, this research employed a qualitative study design, utilising co-creation workshops for data collection. A total of 13 participants were involved in the data collection process. Five people with severe COPD were recruited using purposive sampling. In addition, one family member, four healthcare practitioners, one digital health program designer, and two hospital managers were recruited through convenience sampling. Data were collected during three co-creation workshops. During each workshop, participants were divided into subgroups focused on specific topics. Relevant transcripts from these subgroup discussions were chosen for analysis, which was conducted using qualitative content analysis.

Results: The analysis resulted in four categories that illustrate both the experiences and expectations of people with COPD regarding hospital care from admission to discharge: lack of trustworthy guidance, increased vulnerability during hospitalisation, discharge issues, and advocacy for COPD recognition. Our findings reveal some deficiencies, particularly in admission procedures, information exchange, healthcare interactions, and transitions from hospital to home. At the same time, patients also expressed appreciation for the continuous support provided by COPD nurses and home care teams.

Conclusion: This study highlights the need for person-centred care in managing COPD exacerbations. It identifies key interventions such as early help-seeking, better patient education, staff training, care continuity, improved discharge services, and public awareness. Emphasising individualised experiences, it calls for familiar care settings, collaborative discharge planning, and integration of home care to enhance hospital care quality.

Introduction: Self-conscious emotions, such as shame and guilt, can lead to negative health behaviors in people with chronic obstructive pulmonary disease (COPD). The aim was to investigate which factors – sociodemographic, lifestyle, burden of disease, and healthcare interventions – are associated with self-conscious emotions in people with COPD.

Methods; People with COPD answered a questionnaire with questions about self-conscious emotions, sociodemographic factors, lifestyle, disease burden, and previous healthcare interventions. The relationship between self-conscious emotions and the other variables were analyzed.

Results: A total of 136 participants (68% women, 73.5 ± 7.87 years, FEV1% 53.1 ± 19.3) were included. Emotions of shame were significantly associated with being a woman (p=0.020), reporting physical activity below recommended levels (p=0.029), being a smoker (p=0.018), more severe symptoms (p=0.035), and more exacerbations (p=0.013). Meanwhile, emotions of guilt, worry and grief were significantly associated with reporting physical activity below recommended levels (p<0.001), worse lung function (p=0.018), more symptoms (p<0.001), more breathlessness (p=0.005), more comorbidities (p=0.007), and worse subjective health (p<0.001). No significant associations were found between self-conscious emotions and previous healthcare interventions.

Conclusions: This study reveals significant differences in how people with COPD experience self-conscious emotions, with specific subgroups exhibiting distinct emotional profiles. These emotions may stem from dominant norms in society and can contribute to negative health behaviors. Healthcare professionals need to acknowledge self-conscious emotions and tailor their healthcare interventions accordingly. Because of the small sample size, the findings need to be considered with caution and more comprehensive studies about COPD-related self-conscious emotions are needed.

Background: There is a growing interest in eHealth solutions to enhance access to and use of pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD).

Objective: This study aims to evaluate the feasibility of a novel eHealth tool (Me&COPD) to support pulmonary rehabilitation concerning usability, exercise adherence, intensity, progression, and adverse events. Moreover, this study aims to evaluate clinical outcome measures to prepare for a future larger trial.

Methods: A multicenter, parallel-group randomized controlled pilot and feasibility trial was conducted in 6 primary health care centers. People with mild to severe COPD were recruited by physiotherapists at the included health care centers and randomized either to the intervention group with access to Me&COPD for 3 months or to the control group receiving usual care. The Me&COPD tool comprised audio-visual and written self-management strategies, including an individually tailored home-based exercise program and interaction with a physiotherapist. The exercise program was prescribed in a face-to-face meeting with a physiotherapist, and thereafter it was regularly reviewed and adjusted through the eHealth tool. The primary outcome, usability, was self-assessed at intervention completion in the intervention group and among participating physiotherapists (n=7) using the Swedish version of the Mobile Health App Usability Questionnaire (S-MAUQ). In addition, use data on exercise adherence, intensity, and progression and adverse events were exported from the eHealth tool. Clinical outcomes, assessed by blinded assessors at baseline and 3 months in the intervention and control groups, included exercise capacity, balance, physical activity level, COPD-related symptoms, and health-related quality of life. Descriptive statistics were used for analysis.

Results: In total, 22 participants (women: n=12, 55%), aged 72.3 (SD 8.4) years on average, were included in the intervention (n=15) and control (n=7) groups. The mean overall S-MAUQ scores out of 7 (highest possible usability) were 4.4 (SD 1.5) for participants and 4.5 (SD 1.2) for physiotherapists. Among the subscales, the highest score was assigned to usefulness among participants (S-MAUQ: mean 4.9, SD 1.3) and physiotherapists (S-MAUQ: mean 5.1, SD 1.7). No severe adverse events were registered, although exercise adherence, intensity, and progression evaluation were limited by incomplete exercise session registration. The test procedures and the clinical outcome measures used were found to be feasible for the participants and the assessors.

Conclusions: The novel eHealth tool, Me&COPD, seemed feasible in terms of safety and had acceptable usability among people with COPD and participating physiotherapists. Usability may be improved by better organization of the information and simplification of the exercise diary to enable collection of data on exercise adherence, intensity, and progression through the eHealth tool. The test procedures seemed feasible, although the recruitment process needs further consideration. The effectiveness of the intervention remains to be evaluated in a future larger trial.

Introduction: Patients with chronic obstructive pulmonary disease (COPD) often require treatment from different healthcare professionals at different levels of care. Previous research indicates shortcomings in interprofessional collaboration and rocky transitions between primary care, specialised care and long-term care.

Aim: The aim was to explore how nurses and physical therapists experience their role in interprofessional collaboration and the care delivery pathway for patients with COPD.

Methods: Semi-structured interviews were conducted with nurses (n = 4) and physical therapists (n = 7) from different levels of care between October 2020 and January 2021 and analysed using qualitative content analysis.

Results: Insufficient time and continuity along with unclear routines were perceived as inhibiting interprofessional collaboration and transitions within the care delivery pathway. Dialogue between healthcare professionals was considered important to increase familiarisation with other professional roles and to enhance mutual support. Insufficient competence and low priority in healthcare was perceived as placing responsibility on the silent patient group to contact healthcare for follow-ups.

Conclusions: This study provides insights into the experiences of nurses and physical therapists regarding several insufficiencies in interprofessional collaboration and the care delivery pathway. It is necessary to increase COPD-related competence among healthcare professionals, develop and clarify routines and provide conditions for dialogue between healthcare professionals.

Background: Falls among community-dwelling older adults can be significantly reduced through exercises for balance and strength. Digital solutions show promise in increasing the reach and promote adherence to fall prevention exercises among older adults. However, research on long-term engagement in self-managed fall prevention programs is lacking. The Safe Step application is designed, in collaboration with older adults, to motivate and support them in independently engaging in balance and strength exercises. The aim of this study was to explore longitudinal patterns of older adults’ engagement in self-managed fall prevention exercise supported by the Safe Step digital application.

Methods: A qualitative longitudinal study was nested within a randomized controlled trial that evaluated the effectiveness of the Safe Step application in reducing falls among community-living older adults. A selection of participants who maintained an exercise dose of ≥ 60 min each week was invited to the study. Fifteen participants were included. Each participant was interviewed twice, first at the end of a twelve-month trial period and then after an additional six months. The analysis followed the Pattern-Oriented Longitudinal Analysis approach, analyzing patterns of change over time.

Results: Four engagement patterns were identified that began to emerge during the first year and were consolidated over time: (i) Coherent and sustained pattern, (ii) Coherent and episodic pattern, (iii) Integrated and sustained pattern, and (iv) Integrated and episodic pattern. The long-term engagement in self-managed digital fall prevention was characterized by the degree of cohesion and regularity in training. Initially, all participants followed the exercise recommendations provided by the application. With time they developed different strategies to maintain the exercises that resonated with their own preferences and daily activities. Conclusions: The digital program played a meaningful role in initiating and establishing exercise routines, while other determinants also influenced long-term engagement strategies. Support for self-management of fall preventive exercise needs to evolve over time to meet the changing needs of individuals and their different patterns of exercise engagement. Further research is needed to inform digital interventions aimed at supporting long-term engagement in fall prevention programs.

Chronic obstructive pulmonary disease (COPD) represents a public health challenge and self-management support is crucial to prevent deterioration of health. The Self-Management Assessment Scale was developed to screen for prerequisites for self-management but has not been tested on people with COPD. The study aimed to evaluate the psychometric properties and internal structure of the 20-item Self-Management Assessment Scale in a Swedish COPD population. The 20-item Self-Management Assessment Scale was tested in a sample of 173 participants with a verified COPD diagnosis. Data collection was performed between September 2021 and September 2022. Assessment of content validity by an expert group, confirmatory factor analysis, and test-retest reliability were performed. The scale content validity index (S-CVI) was 0.87, and the number of missing items was low. A moderate to good goodness-of-fit of a five-factor solution was shown. The five factors, Knowledge, Goals for the future, Daily routines, Wellbeing, and Social Support, had correlations within the range of 0.59 to 0.89, with the strongest correlation between Wellbeing and Daily routines. The internal reliability was high for the instrument (0.93) and for each factor (0.73–0.85). Test-retest reliability was good, with no significant difference between scale or factor scores. Good validity and reliability were shown for the Self-Management Assessment Scale and its five key domains. The low number of missing items indicates that the instrument is easy and quick for people to complete. The Self-Management Assessment Scale is, therefore, considered a valuable tool in clinical practice.

Background: Regular physical activity is essential for healthy aging, yet sustaining long-term engagement remains a challenge for many older adults. Emerging research highlights habit formation as a promising mechanism for maintaining physical activity, particularly when supported by contextual cues and digital technology.

Objective: This qualitative study explores how community-dwelling older adults incorporate physical activity into their daily lives, focusing on the processes of habit formation and maintenance, and the role of technology in supporting these behaviours.

Methods: Data were collected through three focus group interviews, one dyadic interview, and two workshop sessions conducted in Umeå, Sweden. Fifteen participants (mean age 73.3 years) with previous experience with regular physical activity contributed to the study. Reflexive thematic analysis was used to interpret the data, following Braun and Clarke’s six-phase approach.

Results: The analysis generated one overarching theme “Staying active through life’s shifting seasons” which captures how participants adapted their physical activity routines in response to aging, health changes, and life transitions. Two interwoven subthemes were identified: “Building the habit scaffold” and “Cultivating a movement mindset”. The first describes how participants constructed supportive frameworks for activity through routines, environmental adjustments, social contracts, and digital technology. The second highlights internal strategies such as emotional reframing, identity alignment, and the development of a personal philosophy around physical activity. Participants emphasized the importance of flexibility, self-awareness, and emotional engagement in sustaining activity. Technology, including smartwatches and fitness apps, was described as both a motivational aid and a feedback system, reinforcing routines and providing a sense of accountability. Seasonal variation and life events were common disruptions, requiring participants to renegotiate their habits and find new forms of physical activity.

Conclusions: Sustaining physical activity in later life is a multifaceted and adaptive process, maintained through the interplay of external scaffolding such as routines, cues, and supportive structures and internal orientations rooted in identity, emotion and meaning. Interventions that are practical, motivational, and flexible are likely to be most supportive. Digital technology can offer valuable support if embedded into personally meaningful and adaptable routines.

Trial registration: NA

Choosing the appropriate design process is critical for the effective implementation and long-term sustainment of interventions aimed at addressing public health challenges. To address this need, we proposed a Transition Design model to identify and deliver sustainable solutions for complex healthcare problems. This model generates system-level health-intervention initiatives that can synergistically function, particularly during the development and implementation phases, to enhance healthcare delivery. Drawing from a case study on addressing the challenges of hospitalisations and early discharge for people with acute exacerbations of chronic obstructive pulmonary disease (AECOPD), we reflected on the process and analysed the outcomes. Although further testing for the initiatives is warranted, this study contributes to the evolving discourse in design research on systems solutioning for public-health challenges.

Assessment of self-conscious emotions is important to develop tailored interventions for people with chronic obstructive pulmonary disease (COPD). Previous instruments have largely been developed for mental health populations. The Self-Conscious Emotions in COPD Questionnaire was the first instrument to assess self-conscious emotions in people with COPD, but it was only available in English.

The aim was to translate the Self-Conscious Emotions in COPD Questionnaire into Swedish and to evaluate its psychometric properties and internal structure in a Swedish context.

The translation process included forward and backward translation, a multidisciplinary meeting, assessment of content validity, and cognitive interviews. The translated instrument was tested in a sample of 173 people with COPD between September 2021 and September 2022. Parallel analysis (PA), exploratory factor analysis (EFA), and test-retest reliability was performed.

The content validity index (CVI) for the instrument was 0.88. Based on the PA, an EFA with a two-factor solution was conducted, with a high Cronbach's alpha (0.786-0.821), and one item about self-blame was excluded. The two factors were labelled: The burden of living with a disability and The desire to hide vulnerability. Test-retest reliability showed no difference between scale scores on factor or item level, except for one item.

The Swedish Self-Conscious Emotions in COPD showed good validity and reliability. One item was excluded from the two subscales, indicating that the instrument needs to be further developed to cover the concept of self-blame. The instrument is expected to be a valuable tool for assessing self-conscious emotions in people with COPD.

Background: Chronic obstructive pulmonary disease (COPD) is one of the most common and deadliest chronic diseases of the 21st century. eHealth tools are seen as a promising way of supporting health care professionals in providing evidence-based COPD care, for example, by reinforcing information and interventions provided to the patients and providing easier access and support to the health care professional themselves. Still, knowledge is scarce on the experience of using eHealth tools from the perspective of the health care professional involved in COPD management.

Objective: The study explored the experiences of using an eHealth tool among health care professionals that worked with patients with COPD in their daily clinical practice.

Methods: This exploratory qualitative study is part of a process evaluation in a parallel group, controlled, pragmatic pilot trial. Semistructured interviews were performed with 10 health care professionals 3 and 12 months after getting access to an eHealth tool, the COPD Web. The COPD Web, developed using cocreation, is an interactive web-based platform that aims to help health care professionals provide health-promoting strategies. Data from the interviews were analyzed using qualitative content analysis with an inductive approach.

Results: The main results reflected health care professionals’ experiences in 3 categories: receiving competence support and adjusting practice, improving quality of care, and efforts required for implementation. These categories highlighted that using an eHealth tool such as the COPD Web was experienced to provide knowledge support for health care professionals that led to adaptation and facilitation of working procedures and person-centered care. Taken together, these changes were perceived to improve the quality of care through enhanced patient contact and encouragement of interprofessional collaboration. In addition, health care professionals expressed that patients using the COPD Web were better equipped to tackle their disease and adhered better to provided treatment, increasing their self-management ability. However, structural and external barriers bar the successful implementation of an eHealth tool in daily praxis.

Conclusions: This study is among the first to explore experiences of using an eHealth tool among health care professionals involved in COPD management. Our novel findings highlight that using an eHealth tool such as the COPD Web may improve the quality of care for patients with COPD (eg, by providing knowledge support for health care professionals and adapting and facilitating working procedures). Our results also indicate that an eHealth tool fosters collaborative interactions between patients and health care professionals, which explains why eHealth is a valuable means of encouraging well-informed and autonomous patients. However, structural and external barriers requiring time, support, and education must be addressed to ensure that an eHealth tool can be successfully implemented in daily praxis.