| Abstract |
Introduction - Purpose:
Chronic Obstructive Pulmonary Disease ranks third globally in morbidity and mortality and is also the fifth leading cause of disability. Given its high prevalence as> 65 million intervention aims are recorded worldwide on an annual basis or with a frequency of occurrence almost equal to the male and female population, there is a need in the scientific community to develop standard models of self-management of the disease (Self-Management). The present study aims to prove the usefulness and effectiveness of the education, information, animation, and empowerment (Self-Management), of patients with C.O.P.D., in the already existing, in the Greek data, structures of Primary Health Care. Methodology-Material:
The study is a randomized intervention study carried out in Primary Health Care structures (TO.M.Y. and H.C.) in the Prefecture of Heraklion, Crete. A total of 120 people with C.O.P.D. participated in the study, of which 40 were in the intervention aim group, and 80 were in the control aim group, provided that they were people visiting Primary Health Care (P.H.C.) structures. The participants were randomized, based on gender and age in both groups. The control group was collected from Health Centers of the Prefecture of Heraklion while the intervention persons from the 4th TO.M.Y. Heraklion. Upon their arrival, the completion of specific demographic data was requested, while in the first and last phase of evaluation (from March to August 2020), the completion of the following clinical tools was requested: SF-12 for quality of life, C.C.Q. for the clinical evaluation of C.O.P.D., mMRC for the assessment of shortness of breath, B.A.I. (Beck Anxiety Inventory) in the assessment of anxiety, B.D.I. (Beck Depression Inventory) with the assessment of depression, HeiQ (Health Education Impact Questionnaire) for the evaluation of education and self-management intervention, H.L.Q. (Health Literacy Questionnaire) for the evaluation of literacy. The intervention group had individual sessions that included the "Training Book" training, with an active discussion. In the interactive part of the intervention (breathing games and reinforcement exercises), the exercises were performed in real-time after the researcher-trainer's instruction.
Results:
The 61.7% in the present study were men, with a mean age of 66 years and older (54.2%), while 72.5% were married or in a relationship. 55% were primary school graduates, and 79.2% had a BMI of over 25kg / m2 (overweight/obese). 52.5% were non-smokers during the study period. The clinical research results of the present study showed that the education, information, animation, and empowerment (Self-Management) of COPD patients improved the disease self-management ability in the control aim group (p <0.05) as there was a positive reduction in COPD symptoms, mainly the degree of shortness of breath, which reached a highly significant controlled level. At the same time, an unexpected decrease was observed in anxiety and depression (p <0.001), contributing to improving life quality. In more detail, theBeck Anxiety Scale (BAI) and the Beck Depression Scale (BDI) showed that was a statistically significant result in reducing stress levels (-35%) and depression (-20.2%) in the intervetion aim group, compared to of the control aim group in which the levels increased (+ 11.6% and + 2% respectively) (p <0.001). Simultaneously, there was a significant decrease in the increased / moderate anxiety and depression levels in the intervetion aim group than the control aim group's same levels' stability. The COPD Scale (Clinical COPD Questionnaire, CCQ) confirmed that the mental state improved in the intervetion aim group (-20.2%) in contrast to the control aim group (deterioration by + 7%). Symptoms decreased in the intervetion aim group (-40.8%) in contrast to the control aim group that increased (+ 1.2%) (p <0.001). The Dyspnea Scale (Modified Medical Research Council-mMRC) assessed the levels of dyspnea in the intervetion aim group, which improved (-38.6%) in contrast to the control aim group, which worsened (+ 2.5%). The above is reflected in the classification of the degree of dyspnea were in the intervetion aim group; the percentage of controlled dyspnea levels increased (+ 37.5%) compared to the control aim group, which worsened with a characteristic decrease (-2%) (p <0.001). The Health Education Impact Questionnaire (heiQ) showed improvement in the intervetion aim group of " Health Directed Behaviour " (intervetion aim: + 9.9% / control aim: -2.7%), of the “Positive and Active Engagement in Life "(intervetion aim: + 6.2% / control aim: -0.7%)," Skill and Technique Acquisition "(intervetion aim: + 6.4% / control aim: -0.4%) and " Health Services Navigation " (intervetion aim: + 5.6% / control aim: -0.3%), with statistical significance (p <0.05). While the Health Literacy Questionnaire (HLQ) scale showed a clear improvement of the intervetion aim group, compared to the control aim group it was noted in the subscales of the "Social Support for Health" (intervetion aim: + 5.5% / control aim: -0.7%), of " Feeling understood and supported by healthcare providers " (intervetion aim: + 6.5% / control aim: -1%), of " Appraisal of health information " (intervetion aim: + 15% / control aim: -1.4%) and " Actively managing my health " (intervetion aim: + 23.5% / control aim: -0.4%), (p<0.05). Finally, a significant increase between the two phases observed in the Intervetion aim Group versus reduction in the Control aim Group, at the levels of Physical Health (+6.10 vs. -0.34, p <0.001) and Mental Health (+5.09 vs. -0.48, p = 0.003) of Quality of Life scale (SF12). Conclusions:
The present research contributes to improving the understanding of self-management needs in the C.O.P.D. The findings underscore the need to create and implement self-management programs in the C.O.P.D., which enhances the patient's energetic attitude towards his health. The educational level, the existence of social support, and the relatively good socio-economic situation are related to the levels of successful self-management of the disease (Self-management), while at the same time affecting the positive emotional and physical symptoms it creates. However, there is a need to investigate whether it helps in long-term situations, especially exacerbations, hospital care, and mortality from the disease or its relationship to cost.
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