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To act or not to act - a sense of control is important for people with chronic obstructive pulmonary disease to increase physical activity: grounded theory study
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. (PROACTIVE - COPD, U-TREX)
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.ORCID iD: 0000-0002-8257-503X
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.ORCID iD: 0000-0003-0569-9490
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. (PROACTIVE - COPD)ORCID iD: 0000-0001-7334-8698
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2023 (English)In: JMIR Formative Research, E-ISSN 2561-326X, Vol. 7, article id e39969Article in journal (Refereed) Published
Abstract [en]

Background: Among people with chronic obstructive pulmonary disease (COPD), low level of daily physical activity (PA) is the main risk factor for developing cardiovascular, metabolic, and musculoskeletal comorbidities. Increasing PA in people with COPD is complex as PA behavior itself is complex and multifaceted, including personal, physiological, and psychologicalelements as well as social and environmental factors. Although eHealth solutions such as web-based support or websites haveshown positive effects on PA in people with COPD, the results are inconclusive, and it is still unclear how eHealth solutionsmight be used to support positive changes in PA behavior in people with COPD.

Objective: This study aimed to explore the perceptions of increasing objective PA when using a web-based eHealth tool amongpeople with COPD.

Methods: This study was part of a pragmatic randomized controlled trial with in-depth interviews between the 3- and 12-month follow-ups. The methodology used was constructivist grounded theory. All sampling included participants from the randomized controlled trial intervention group, that is, participants who had access to the eHealth tool in question and agreed to be contacted for an in-depth interview. Inclusion of participants continued until data saturation was reached, resulting in an inclusion of 14 (n=8, 57% women) participants aged between 49 and 84 years and living in 8 municipalities in Middle and Northern Sweden. Two interviews were conducted face-to-face, and the remaining interviews were conducted via telephone. All interviews were recorded using a Dictaphone.

Results: The analysis resulted in 3 main categories: welcoming or not welcoming action, having or lacking resources, and lowering the threshold. The first 2 categories contain barriers and facilitators, whereas the third category contains only facilitators. The categories lead to the more latent theme Perceiving enough control to enable action, meaning that it seems that perceiving the right amount of control is essential to maintain or increase the level of PA when using an eHealth tool, among patients with COPD. However, the right amount of control seemed to depend on the individual (and context) in question.

Conclusions: The core category indicates that a need for a certain sense of control was interpreted as necessary for increasing the PA level as well as for using an eHealth tool to help increase the PA level. The eHealth tool seemed to strengthen or weaken the perception of control by either providing support or by being too demanding on the user. Perceptions varied depending onother environmental factors. The Fogg Behavior Model illustrated how motivational levels, ability levels, and functional triggers interact within our findings. Thus, this study provides further evidence for the importance of empowering the patients to boost their level of agency and their ability to improve PA levels.

Place, publisher, year, edition, pages
JMIR Publications , 2023. Vol. 7, article id e39969
Keywords [en]
physical activity, chronic obstructive pulmonary disease, COPD, eHealth, interview, eHealth tools
Keywords [sv]
KOL, kroniskt obstruktiv lungsjukdom, fysisk aktivitet, eHälsa, intervju
National Category
Physiotherapy
Research subject
physiotherapy; Public health
Identifiers
URN: urn:nbn:se:umu:diva-204180DOI: 10.2196/39969ISI: 000998490100036Scopus ID: 2-s2.0-85149129676OAI: oai:DiVA.org:umu-204180DiVA, id: diva2:1732286
Note

Originally included in thesis with title: "To Act, or Not to Act, a Sense of Control Is Important for People With Chronic Obstructive Pulmonary Disease to Increase Physical Activity: Grounded Theory Study"

Available from: 2023-01-30 Created: 2023-01-30 Last updated: 2024-03-22Bibliographically approved
In thesis
1. COPD management: exploring conditions for, and experiences of, evidence-based care and eHealth
Open this publication in new window or tab >>COPD management: exploring conditions for, and experiences of, evidence-based care and eHealth
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Behandling av KOL : undersökning av förutsättningar för, och erfarenheter av, evidensbaserad vård och eHälsa
Abstract [en]

Background: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and premature death worldwide. It is a systemic disease that affects the whole person, although dyspnea is the mostprominent symptom. COPD is expected to increase in prevalence during the coming 40 years due to an increase in relevant risk behaviors, and today over 230 million people suffer from COPD worldwide. A common extra pulmonary manifestation of the disease is quadriceps dysfunction, where muscle strength, power, and/or endurance properties are reducedand affect everyday function. However, reference values and valid reference equations are needed to evaluate and offer appropriate treatment for quadriceps dysfunction. Moreover, a crucial part of COPD management is pulmonary rehabilitation, e.g., where disease management and strategies are conveyed and put into practice. However, due to knowledge gaps within health care, we need to develop new ways of informing and supporting people with COPD. One way is through eHealth, although these sources must be evaluated so that they constructively contribute to health care.

Aim: The overall aim of this thesis is to explore the conditions for, and perspectives on, evidence-based care and eHealth in COPD management. This aim is twofold. The first is to explore the experiences, interactions, and context of using eHealth tools in managing COPD in primary carefrom the perspective of people with COPD and health care professionals (HCPs). The second is to develop reference values and equations for quadriceps function.

Method: This dissertation contains three papers (Papers I, II, and III) based on individual interviews analyzed with qualitative research methods in which an eHealth tool, the COPD Web, is evaluated. Lastly, it contains one paper(Paper IV) based on an international multicenter data collection analyzed with quantitative research methods.

Results: Paper I: The findings indicate that the level of motivation, comfortability with IT tools, and health literacy seem to affect the usage of an eHealth tool over time. Some level of use and the passage of time appears to be needed to perceive gained benefits from the eHealth tool. In short, this suggests that eHealth tools such as the COPD Web can be suitable for supporting COPD-specific self-management skills. Paper II: The findings indicated that using the COPD Web provided knowledge support for HCPs and improved the quality of care for people with COPD. However, it seems some barriers need to be addressed to successfully implement the eHealth tool in daily practice. Paper III: Findings lead to the theme “Perceiving enough control to enable action”, which suggests that having or perceiving a certain amount of control is essential to maintain or increase the level of physical activity when one has COPD and uses an eHealth tool. Paper IV: The findings indicate that for people without COPD, age, sex, height, and BMI explained 50 – 70 % of the variance of quadriceps strength, endurance, and power. Our findings also suggested moderate construct validity of the reference equations in people with COPD.

Conclusion: To conclude, the web-based eHealth tool, the COPD Web, seems to support and help when self-managing COPD and treating people with COPD. There are still barriers for people with COPD to use a web-based eHealth tool, and we probably ought to screen people with COPD for health literacy before discussing and deciding on PR strategies with them. There are still barriers to implementing new tools in the health care setting, which should need time, support, and education to circumvent. Findings regarding the developed reference values and equations for quadriceps strength, power, and endurance will make further tailoring of the treatment regime for the individual possible. As such, this, too, should assist in improving disease management, although the construct validity of the equations was moderate.

Abstract [sv]

Bakgrund: Kroniskt obstruktiv lungsjukdom (KOL) är en av de vanligaste sjukdoms- och dödsorsakerna i världen. Det är en sjukdom som påverkar hela individen, inte bara lungorna, där andfåddhet är det vanligaste symptomet. Under de kommande 40 åren väntas andelen personer som diagnosticeras med KOL att öka eftersom relevanta riskbeteenden blir vanligare hos befolkningen.En vanlig följd av KOL är en nedsatt styrka, explosivitet (power) och/eller uthållighet i skelettmuskulatur, specifikt quadriceps (lårmuskel), som leder till dysfunktion vid vardagsaktiviteter. För att utvärdera funktionen, samt erbjuda relevant behandling, behövs referensvärden och validerade referensekvationer. Vidare är en av de viktigaste delarna av behandling vid KOL lungrehabilitering, där personer med KOL exempelvis får lära sig hur man kan hantera symptom och ta hand om sig själv på ett bra sätt i relation till sjukdomen. Tyvärr finns kunskapsglapp inom sjukvården vilket innebär att vi behöver hitta nya informationsvägar gällande KOL-specifik kunskap och stöttning åt personer med KOL. Ett av alternativen för kunskapsspridningen är genom eHälsa, vilket fortsatt behöver utvärderas för att säkra att de tillför konstruktiv och användbar hjälp inom vården och hos personer med KOL.

Syfte: Det övergripande syftet i avhandlingen är att utforska förutsättningar för, och perspektiv på, evidensbaserad vård och eHälsa kopplat till behandling av KOL. Syftet är dubbelt. Å ena sidan till att utforska erfarenheter, interaktion och kontext kring behandling av KOL i primärvården utifrån personer med KOLs respektive hälso- och sjukvårdspersonals perspektiv. Å andra sidan syftar avhandlingen till att utveckla referensvärden och referensekvationer för lårmuskelfunktion.

Metod: Avhandlingen innehåller tre intervjustudier (Paper I, II och III) utförda med kvalitativa forskningsmetoder som utvärderat ett eHälsoverktyg, KOLwebben, och en internationell multicenterstudie (Paper IV) som analyserats med kvantitativ forskningsmetod.

Resultat: I de tre intervjustudierna fann vi att det webbaserade eHälsoverktyget, KOLwebben, tycks vara en källa till vidareutbildning och förbättrade behandlingsmöjligheter för både vårdhälsopersonal och personer som har KOL. Bland båda grupper sågs olika facilitatorer och hinder, te.x. behövs ett visst mått av hälsolitteracitet, känsla av kontroll, trygghet kring IT-verktyg och motivation för att personer med KOL ska använda verktyget och märka av förbättring i sitt tillstånd. Hos vårdpersonal behövdes en förankring av den nya arbetsmetoden inom arbetsplatsen eller vårdapparaten för att genomgå en lyckad implementeringsprocess och märka av en förbättring i vården av personer med KOL. För båda grupper gällde att tid var en viktig ingrediens, man behövde tid för att sätta sig in, förstå och implementera nya lärdomar i övriga livet. I den fjärde studien utvecklade vi referensvärden och referensekvationer för styrka, explosivitet (power) och uthållighet i lårmuskulaturen. Resultaten indikerade att för personer utan KOL förklarade ålder, kön, längd och BMI 50 – 70 % av variansen för lårmuskelstyrka, -uthållighet och -explosivitet (power). Utvecklade referensekvationer visade på måttlig begreppsvaliditet bland personer med KOL.

Slutsatser: Det webbaserade eHälsoverktyget, KOLwebben, uppfattas som ett stöd och hjälp när det gäller såväl egenvård som vård av KOL. Det finns dock hinder för att personer med KOL ska kunna använda ett webbaserat eHälsoverktyg såsom KOLwebben och fynden från denna avhandling indikerar att screening av personer med KOL gällande hälsolitteracitet bör övervägas för att kunna erbjuda lämplig lungrehabilitering (digital eller ej). Det finns även hinder för användning av eHälsoverktyg såsom KOLwebben inom vården, där mer tid, stöttning och utbildning tycks krävas för att komma vidare. De utvecklade referensvärderna och referensekvationerna för lårmuskelstyrka, -explosivitet (power) och -uthållighet kommer att möjliggöra ännu bättre personcentrerad vård,vilket i sig kommer att ge en bättre KOL-specifik behandling med måttlig begreppsvaliditetet.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2023. p. 92
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2221
Keywords
physical activity, chronic obstructive pulmonary disease, COPD, eHealth, interview, eHealth tools, reference equations, muscle dysfunction, COPD management
National Category
Physiotherapy
Research subject
physiotherapy
Identifiers
urn:nbn:se:umu:diva-204243 (URN)978-91-7855-975-6 (ISBN)978-91-7855-976-3 (ISBN)
Public defence
2023-02-24, Triple Helix, Samverkanshuset, Umeå universitet, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2023-02-03 Created: 2023-01-31 Last updated: 2023-02-01Bibliographically approved

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Marklund, SarahSörlin, AnnStenlund, TobiasWadell, KarinNyberg, Andre

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