Understanding the impact of COPD and self-management interventions: a self-determination theory perspective.

Abstract

People with COPD (pwCOPD) experience a range of daily living limitations caused by breathlessness, which can affect their quality of life and physical and mental health. There are approximately 1.2 million pwCOPD in the UK. Two common behavioural interventions are self-management support and pulmonary rehabilitation, which support pwCOPD to exercise and adopt techniques to decrease their symptoms; however, adherence to these can be poor. This study aimed to understand whether these two different interventions can affect motivational concepts and explore how pwCOPD experience their condition and these interventions. This study used a mixed-method design. Participants were allocated to receive either: pulmonary rehabilitation and PocketMedic (a self-management intervention), only PocketMedic, or only pulmonary rehabilitation. Questionnaires measuring self-determination theory motivational concepts were completed at baseline and seven weeks. Semi-structured interviews were conducted and analysed using Reflexive Thematic Analysis. 53 participants were recruited to the three conditions. An ANOVA found no statistically significant differences between the groups for any of the questionnaires, which may be related to the low sample size. However, when the research condition was held constant, significant improvements were identified for competence satisfaction (p < 0.001) and relatedness satisfaction (p < 0.05) and autonomy frustration (p < 0.001) and competence frustration (p < 0.05). Seven participants from the PocketMedic conditions were interviewed. Overarching themes described the participants' experiences and adaptations to psychological need frustration, and how the interventions facilitated basic psychological need satisfaction. This study suggests that pulmonary rehabilitation and PocketMedic can improve basic psychological need satisfaction and frustration; however, there were no cumulative affects when the interventions were combined. Need frustration is important to consider in research on long-term conditions. The qualitative analysis provides greater knowledge on mechanisms by which healthcare interventions have been shown to be effective. Further research is needed including larger and more diverse samples to enable complete generalisability.