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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 15  |  Issue : 3  |  Page : 246-257

Effect of educational programs on knowledge and self-management of patients with chronic obstructive pulmonary disease


1 Department of Medical Surgical Nursing, Faculty of Nursing, Tanta University, Tanta, Egypt
2 Department of Community Health Nursing, Faculty of Nursing, Helwan University, Cairo, Egypt

Date of Submission24-Oct-2017
Date of Acceptance25-Jul-2018
Date of Web Publication28-Dec-2018

Correspondence Address:
Mona M Abd El-Maksoud
Faculty of Nursing, Helwan University, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ENJ.ENJ_41_17

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  Abstract 


Background Patient education has a vital role in caring for patients with chronic obstructive pulmonary disease (COPD), and a corner stone of self-management in chronic illnesses.
Aim of the study This study aimed to evaluate the effect of educational programs on the knowledge and self-management of patients with COPD.
Methods This study was carried out on 40 COPD patients at outpatient follow-up Medical Clinics at Tanta University Hospital. The researchers interviewed them using an interview schedule to assess the sociodemographic characteristics, patients’ medical history, physical examination, and knowledge regarding COPD and an observational checklist to assess self-care practice of the patient.
Results The results have shown significant differences in relation to decrease in the signs of cough, sputum, and shortness of breath immediately and after 2 months of implementing the self-care management program, but there were no significant differences in relation to other signs of the disease. The majority of patients (95%) had poor knowledge, and all of them had unsatisfied practice regarding self-management skills for COPD before implementation. Immediately postimplementation of the educational program, the study showed highly statistically significant improvement in total score of knowledge, where the majority of them had a fair knowledge and good practice regarding COPD; these scores decreased in post-test 2.
Conclusion This study concluded that the education of patients regarding knowledge for COPD and healthcare practice is very effective in improving their self-management skills, but they need reinforcement follow-up. Therefore, this study recommended that the healthcare personnel should provide health education for COPD patients on self-care to their improve knowledge which helps prevent complications and maintain their life.

Keywords: chronic obstructive pulmonary disease, knowledge, patients, self-care practice, self-management


How to cite this article:
Ibrahim RA, Abd El-Maksoud MM. Effect of educational programs on knowledge and self-management of patients with chronic obstructive pulmonary disease. Egypt Nurs J 2018;15:246-57

How to cite this URL:
Ibrahim RA, Abd El-Maksoud MM. Effect of educational programs on knowledge and self-management of patients with chronic obstructive pulmonary disease. Egypt Nurs J [serial online] 2018 [cited 2019 Jan 17];15:246-57. Available from: http://www.enj.eg.net/text.asp?2018/15/3/246/248969




  Introduction Top


Chronic obstructive pulmonary disease (COPD) is considered a public health problem over the world. The morbidity, mortality rate, and the prevalence are expected to increase related to a rapidly aging population and rising smoking rates (Feenstra et al., 2001). Its prevalence, differ across countries. The fourth most common cause of death in the world is COPD; moreover, it is the third leading cause of death in the USA {Rabe et al., 2007; Nishiyama et al., 2010}. In Egypt, COPD is a rising significant health problem; however, information on its prevalence, morbidity, and mortality is still lacking (Said et al., 2015). Accordingly, Healthy People 2020 objectives aim to reduce hospitalization rates and reduce hospital emergency department visit (National Center for Health Statistics, 2015).

COPD can be prevented and treated. The progressive airflow limitation and abnormal inflammatory response of the lung to noxious particles and/or gases are the characteristics of the disease (Vestbo et al., 2013). Exposure to inhaled irritants such as tobacco smoke can result in chronic inflammation of the airways, lung tissues, and pulmonary blood vessels. The inflammatory process can lead to tissue damage as well as a range of systemic effects. The chronic inflammation present is related to the process of the disease and leads to various damage of the lung and airflow limitation (Barnes, 2008; Toraldo et al., 2013).

Airway obstruction results in prolonged episodes of coughing and dyspnea (i.e. shortness of breath), exacerbations which can cause fear leading to avoidance of regular activity, causing additional deconditioning that can aggravate dyspnea even further (Reardon et al., 2006). Genetic factors, outdoor and indoor air pollution, second-hand smoke exposure, biomass smoke, occupational exposures, tuberculosis, and longstanding asthma are considered the common risk factors for the disease {Eisner et al., 2010}. The burden and prevalence of COPD are expected to increase in the next years related to persistent exposure to risk factors of the disease and increase in the world’s aging population. As in developing countries these factors are rapidly increasing; COPD will become a major health problem, exerting a huge demand on economic and healthcare resources (Chan-Yeung et al., 2004).Self-care management is considered an integral component of the chronic care model of disease management. Clinical information systems, delivery system redesign, decision support (guidelines), healthcare organizations, and community resources are considered the components of disease management. Self-care management helps the patient maintain the knowledge and the skills required to follow those medical therapies and health behavior changes required to achieve optimal outcomes (Bourbeau and van der Palen, 2009). COPD self-care management refers to engaging in activities that promote adequate inhalation, positions and postural drainage techniques, physical activity, and prevent adverse health outcomes (Korff et al., 1997).


  Significance Top


It has been observed by the researchers at Tanta University Main Hospital Chest Department that most of the hospitalized COPD patients have inadequate knowledge and skills about their self-care practice. It is expected that the data generated from this study could help in planning and providing self-care management programs for COPD patients to provide education and training for those patients.


  Aim Top


The aim was to evaluate the effect of educational programs on the knowledge and self-management of patients with COPD.

Hypotheses

  1. COPD patients who are exposed to the self-care management program will have a higher total knowledge score than those who did not attend the program.
  2. COPD patients who are exposed to the self-care management program will have a higher total practice score than those who did not attend the program.



  Patients and methods Top


Research design

The study design was quasi experimental.

Settings

The study was conducted at the outpatient follow-up Medical Clinics at Tanta Chest Hospital affiliated to Tanta University.

Sampling

Purposeful sample composed of 40 patients selected from the previously mentioned study settings. They were diagnosed with COPD according to the Global Initiative for Chronic Obstructive Lung Disease guidelines [Global Initiative for Chronic Obstructive Lung Disease {GOLD), 2010}.

The patients were chosen according to the following criteria:
  1. Patient under medical treatment.
  2. Had no chronic disease other than COPD.
  3. Age ranged from 30 to 60 years.


Tools for data collection

They were developed by the researchers after reviewing the literature and previous studies related to COPD. Two different tools were used to collect data for this study. They included an interview sheet and an observational checklist:
  1. Tool I (COPD questionnaires): it consists of the following four parts:
    1. Part 1: it was concerned with demographic characteristics and medical data such as age, sex, income, occupation, and smoking status, duration of disease, times of hospitalization, family history, etc.
    2. Part 2 (present history): presence of chronic cough, chronic sputum production, and shortness of breath; grading of dyspnea using a modified medical research council dyspnea scale, chest wheezing, etc.
    3. Part 3 (physical examination):
      1. General examination: including general appearance, body weight, height, and BMI.
      2. Local chest examination: prebronchodilator and postbronchodilator spirometric study according to the GOLD (2010).
    4. Part 4: it included the patient’s knowledge such as part of the body affected by the disease, common risk factors, symptoms, complications of the disease, management, and practice regarding COPD such as postural drainage, coughing, breathing, pursed lip breathing exercises, physical activity, dietary behavior, activity of daily living, sleeping pattern, medication compliance, and using metered-dose inhaler.
  2. Tool II (observational checklist): it was developed by the researchers based on the related studies to assess the self-care practice of the patient with COPD regarding oxygen therapy, postural drainage, pursed lip breathing, diaphragmatic breathing exercises, and using metered-dose inhaler.


Scoring systems

  1. COPD is classified into three stages:
    1. Stage I: mild as forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) less than 70% and FEV1 less than or equal to 80%.
    2. Stage II: moderate as FEV1/FVC less than 70% and FEV1 50–80%.
    3. Stage III: severe as FEV1/FVC less than 70% and FEV1 30–50% (GOLD, 2010).
  2. A modified medical research council dyspnea scale: it consisted of five statements that are graded from none (0) to the highest level of dyspnea (4) (Nishiyamaet al., 2010).
  3. The BMI is calculated according to the WHO (2008) classification: normal BMI=18.5–24.9 kg/m2, overweight BMI=25.0–29.9 kg/m2, obesity BMI=30.0–39.9 kg/m2, and extreme obesity BMI=40.0 kg/m2.
  4. The unit for measuring the amount a person has smoked over a long period of time is the pack-year and calculated by multiplying the number of packs of cigarettes smoked per day by the number of years the person has smoked. As: 1 pack-year is equal to smoking 20 cigarettes (1 pack) per day for 1 year, or 40 cigarettes per day for half a year, and so on. Number of pack-years=(packs smoked per day)×(years as a smoker) (WHO, 2008).
  5. Total score of knowledge: 28 closed-ended questions covering the main areas such as definition of the disease, risk factors and causes, signs and symptoms, complications, physical activity, coughing and breathing exercises, medication, smoking, nutrition, vaccination, and follow-up. Each correct and complete answer was given 1 score, while wrong and no answer was given 0 score. The total scores ranged from 0 to 28. The total level of knowledge was categorized as follows: less than or equal to 50% was graded as poor or unsatisfied, 50% to less than 75% score was graded as fair or satisfied, and greater than or equal to 75% score was graded as good.
  6. Total score of observational checklist: it assessed the self-care practice of a patient with COPD (38 steps) regarding oxygen therapy (11 steps), postural drainage (six steps), pursed lip breathing, diaphragmatic breathing exercises (six steps), and using metered-dose inhaler (15 steps). Two scores were given for each step that was done correctly, one score for the incompletely done step, and 0 for the step that was not done. The total level of practice score was categorized as: less than 60% of the total score was considered poor, from 60% to less than 75% was considered fair, and from 75% and more was considered good.


Pilot study

The pilot study was conducted on 10% of the total sample; they were excluded from the study sample. It is done to test the clarity, feasibility, and applicability of the study tools. Modifications and omissions of some details were done and then the final forms were developed based on the result of the pilot study.

Ethical consideration

The study protocol was approved by pertinent research and ethics committees. Informed consent was taken from every patient before inclusion in the study. The participants were assured that all data are highly confidential; anonymity was also assured by assigning a code number for each patient instead of names to protect their privacy. Data were available only to the researchers and the participants. A complete description of the purpose and nature of the study was given to the participants and the verbal consent was taken from each of them.

Procedures of data collection

  1. An official permission to conduct the study was obtained from the directors of Tanta University Main Hospitals. The researchers explained to the patient their ethical rights and got their consent.
  2. Data were collected over a period of 6 months from November 2016 to April 2017.


Each patient was interviewed individually three times to collect the data before implementing the educational program, immediately and 2 months after implementing the educational program.

The study was conducted on four phases which included the following:
  1. Assessment phase: two tools were used to collect the data, the questionnaire and checklist for practice of patients who fulfill the inclusion criteria of the study.
    • Tool I: the questionnaire assessment sheet included demographic characteristics, present history, and patients’ knowledge part 1, 2, and 4 translated into Arabic language by the researchers based on the literature review. They were filled by the patients who can read and write and by the researchers for those who were illiterate. Part 3 concerned with general physical examination was filled by the researcher, the local physical examination patients prebronchodilator and postbronchodilator spirometric study according to the GOLD (2010) were obtained in the clinic. The patients who cannot perform spirometry were included only if there were previous spirometric documents available. Each interview lasted for about 30–45 min to complete this tool.
    • Tool II: observational checklist of the patients’ self-care management was filled by the researchers, it was filled three times as mentioned previously. It assessed self-care practices of the patient with COPD regarding oxygen therapy, postural drainage, pursed lip breathing, diaphragmatic breathing exercises, and use of metered-dose inhaler. The time needed to complete the checklist varies from 30 to 45 min depending on the patient’s ability to perform the activity.
  2. Planning phase: in this phase, a plan was formulated for each patient based on assessment phase and literature review; the researchers prepared the training places, teaching aids, and media (videos, picture, and handouts). A booklet as a teaching aid was prepared, and then revised by a group of experts in the medical surgical nursing and community health nursing at faculties of nursing for content validity.
  3. Implementation phase: a clear and simple explanation was offered to patients about the aim of the study and its expected outcomes for them. The total numbers of 40 patients were divided into six groups of 6–7 patients and the total study sessions were 12; four sessions for the theoretical part and other eight sessions for practice and demonstration. The program was introduced over a period of 6 weeks, two sessions/week. Each session ranged from 45 to 60 min. A copy from the booklet was given to each patient. The teaching/training methods were: discussions, as well as demonstration and redemonstration. The teaching media were illustrative pictures, PowerPoint presentation, doll, and handouts. Each session took 45–60 min. The teachings were designed and presented in Arabic language. At the beginning of the first session, an orientation to the health guideline and its purpose were presented. Each session started by a summary of what had been taught in the previous session and the objectives of the new one, taking into consideration the use of simple language to suit the level of patients. The researchers used motivation and reinforcement during the educational sessions to enhance learning. The booklet and PowerPoint were prepared by the researcher based on literature review. The booklets were distributed to the studied nurses at the end of sessions as a copy to use it.


Description of the educational program

Aim of the program was to provide the COPD patients with knowledge and self-care practice

Content: intervention program was developed by the researchers based on the related literature. Knowledge about COPD included basic anatomy and physiology of the lungs, causes and risk factors of the disease, signs and symptoms, diagnostic measures, and pharmacological and nonpharmacological management. Self-care management included physical activity, dietary behavior, activity of daily living, sleeping pattern, postural drainage, coughing, breathing exercises, pursed lip breathing, and use of metered-dose inhaler or nebulizer.

Division of sessions

Four theoretical sessions

  1. Two sessions included introduction to anatomy and physiology of the lungs, definition of the disease, risk factors and causes of the disease, and complications of the disease.
  2. Two sessions included diagnostic measures and lab investigation, management of exacerbation, pharmacological, and nonpharmacological measures.


Eight practical sessions

  1. Five sessions included oxygen therapy, positions and techniques of postural drainage, exercises and physical activity, coughing, breathing, diaphragmatic, and pursed lip breathing exercises.
  2. Three sessions included needed equipment and steps of using metered-dose inhaler and nebulizer, oral medication, corticosteroids, and injection.


Evaluation phase

The evaluation of the effectiveness of the educational program was carried out immediately postprogram implementation and after 2 months using the pretest questionnaire and the observation checklist.

Statistical analysis

The collected data were organized, tabulated and statistically analyzed using the statistical software SPSS version 16 (SPSS Inc., Chicago, Illinois, USA). For quantitative data, the mean, and SD were calculated. χ2-test and one-way analysis of variance test were used. The correlation between variables was evaluated using Pearson’s correlation coefficient (r). A significance was adopted at P value of less than 0.05 for clarification of results of tests of significance.


  Results Top


[Table 1] shows the distribution of demographic data among the studied patients. The results have shown that 50% of the sample were aged more than 50 years and 80% of them were men while 67.5% and 72.5% were married and lived in rural areas, respectively. Of the patients, only 57.5% can read and write, 42.5% were construction workers, and 75% had no health insurance and the family income was not enough for all of the participant patients.
Table 1 Distribution of demographic data among the studied patients (n=40)

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[Table 2] indicates that 57.5% were smokers, 62.8% of them smoked two cigarette packs per day, 90% of the patients had a history of the disease for more than 3 years, and 65% of patients had no family history of the disease; 65% of them were admitted to hospital previously for more than three times.
Table 2 Distribution of health-related data among the studied patients (n=40)

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[Table 3] clarifies the distribution of the studied sample in relation to physical examination throughout the periods of the study. The results have shown that there were significant differences in relation to cough, sputum, and shortness of breathing immediately and after implementation of self-care management programs. While 57.5% of the patients had grade III of dyspnea, there were no significant differences in relation to other signs of disease such as barrel chest, bulging neck vein, swelling of the leg, poor appetite, restlessness, weight loss, insomnia, and cyanosis.
Table 3 Percentage distribution of the studied sample in relation to physical examination throughout the periods of the study

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[Table 4] illustrates that 67.5% of the participant patient had FEV1 and FVC ratio of less than or equal to 70%, while 70% of them had FEV1 less than or equal to 80% and 25% had FEV1 50–80% on admission, but no data were available immediately and 2 months after implementation of the program.
Table 4 Percentage distribution of the studied sample in relation to lung function investigation before the program (n=40)

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[Table 5] Pre-implementing educational self-care program. The results showed that half of patients did not have the knowledge about the meaning of the disease, its signs and symptoms, and importance of follow-up. While more than half of the patients did not know the importance of physical activity and use of medications (67.5 and 62.5% respectively), 82.5% of them knew the relation between smoking and the disease, while 100% of patients had no knowledge about the importance of vaccination.
Table 5 Percentage distribution of the studied sample in relation to knowledge throughout the periods of the study

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Immediately after implementing the educational self-care program, more than have of the patients showed improvement in their knowledge regarding meaning, risk factors, signs, complications of the disease, and importance of follow-up.

Two months after implementation of the educational self-care program, the study showed decreasing level of patients’ knowledge regarding items of coughing and breathing exercises, importance of vaccination, and follow-up.

[Table 6] indicates that about 95% had poor knowledge preprogram, while after program the majority of them had fair knowledge immediately (95%), and 2 months postprogram (75%). The table shows that there were highly statistically significant differences in relation to the total knowledge level and its range before, immediately, and 2 months after the program implementation at (P=0.00).
Table 6 Percentage distribution of the studied sample in relation to their total knowledge level throughout the periods of the study (n=40)

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[Table 7] shows distribution of the studied sample in relation to self-care practices throughout the periods of the study. Preimplementing educational self-care program: more than half of the patients (65%) could not perform pursed lip and diaphragmatic breathing, while 75% of them could not apply the procedure of oxygen therapy; moreover, all of them could not perform postural drainage techniques.
Table 7 Percentage distribution of the studied sample in relation to self-care practices throughout the periods of the study.

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Immediately after implementing the educational self-care program: majority of the patients (82.5%) applied pursed lip and diaphragmatic breathing correctly, while 72.5, 62.5, 52.5% of them had correct application of the metered-dose inhaler, postural drainage, and oxygen therapy techniques, respectively.

Two months after implementation of the educational self-care program: half of the patients used metered-dose inhalers incompletely correct, also more than half of the patients (62.5%) applied pursed lip, diaphragmatic breathing, and postural drainage correctly.

[Table 8] clarifies the distribution of the studied sample in relation to their total practice level; all the studied participants had unsatisfied practice at pretest, but immediately after implementation of the program about half of them (47.5%) got a satisfied score and 52.5% were good. Also about two-thirds of the studied group (62.5%) had satisfied practice and about one-third of them obtained a good score (32.5%) 2 months after program implementation.
Table 8 Percentage distribution of the studied sample in relation to their total practice level throughout the periods of study (n=40)

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In addition, there was highly statistically significant differences in relation to practice before, immediately, and 2 months after program implementation at P value of 0.00.

[Table 9] shows the correlation between demographic characteristics, total practice score of the studied sample, and their knowledge. The findings have shown that there were highly statistically significant correlations among patients’ education, residence, marital state and crowding index, and their knowledge regarding COPD. While, there were no correlations between lack of patients’ knowledge and their sex and age regarding the correlation between demographic characteristics of the studied sample and their practice.
Table 9 Correlation between demographic data and total knowledge score of the studied sample throughout the periods of the study

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[Table 10] shows that there were no statistically significant correlations between patients’ demographic and their practice regarding COPD self-management at all the stages of the program.
Table 10 Correlation between sociodemographic data and total practice score of the studied sample throughout the periods of the study

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  Discussion Top


In patients with COPD, it is important for them to know about their disease and its management for a better therapeutic outcome, as patients’ awareness enables them acquire better self-management skills, and improves their quality of life. Hence, this study was carried out to evaluate the effect of the educational program on knowledge and self-management of those patients. Also, it was hypothesized that the COPD patients who are exposed to the self-care management program would have higher total knowledge and practice scores than those who did not attend the program.

Regarding characteristics of the patients under the study, it was found that a half of the studied samples were of 51–60 years. This was in agreement with the results of the study done in Egypt by Mohamed et al. (2017) who reported that the age of more than half of the patients with COPD were more than 50 years, while, this finding was inconsistent with Tel et al. (2012) who found out that the age of the COPD patients in their study was more than 66 years. Most of the studied sample were men; this finding was also congruent with Salah et al. (2013) who found that the majority of the studied sample were men. This finding might be in fact due to the higher prevalence of smoking among men and the frequent occupational exposures to irritating work environment than women. On the contrary, some previous studies have shown that the male sex is not a risk factor for COPD, and it has appeared that women could be more prone to COPD (Centers for Disease Control and Prevention, 2013).

The findings of the present study have shown that more than two-thirds of the studied sample were from rural area. An Egyptian study done by Badway et al. (2016) indicated that the prevalence of COPD is more between rural than urban population. This might be in fact due to the exposure of patients in rural area to rice-grass burning, using wood, and agricultural crop residues, which lead to greater destruction of airway with more chest symptoms. Also they live in houses with high crowding index (mean=1.257) that might transmit infection among family members. All these are considered major risk factors for COPD. This result coincided with what was found by De Queiroz et al. (2015) who stated that exposure to smoke from a wood-burning stove was recognized as a COPD risk factor among the respondents.

More than half of the studied sample was blue-collar workers; the high prevalence of COPD among blue collars may be because of exposure to irritants at their work places causing serious lung damage as most of those patients were working in the agriculture sector and construction workers. Also it was found that the majority of the studied participants were smokers and passive smokers. According to the National Heart, Lung and Blood Institute (2018). COPD most often occurs in people with a history of smoking. In another study conducted in Spain by Leiva-Fernández et al. (2014) found a high prevalence in the male sex, most likely because of the smoking habits. Tobacco is considered a major risk factor and important initial diagnostic for COPD.

As regards the clinical characteristics of the studied participants, it was found that most of the patients had a disease for more than 1 year and two-thirds of them were hospitalized before about three times or more. These results were similar to the findings of Baghai-Ravary et al. (2009) who found increasing hospitalization rates for the patients with COPD. Inconsistent with this finding, an Egyptian study done by El-Gendy et al., (2015) showed that more than half of the patients (57%) were diagnosed as COPD for more than 1 year and 59.0% of them were not hospitalized before and only 4.0% were hospitalized three times or more before. Also, most of the studied group had cough, sputum, dyspnea, and restlessness. These symptoms were strongly associated with the presence of COPD. This was in agreement with Badway et al. (2016) who found that the majority of COPD patients had dyspnea, cough, and wheezing chest.

In the current study, more than half of the patients had a low educational level, and the rest of them were illiterate, which could contribute to poor health awareness. Thus, an educational intervention adapted to these patients using the audiovisual material could improve the clinical outcomes by teaching appropriate self-management skills.

Regarding the patients’ level of knowledge preimplementation, the findings of the present study indicated that, the majority of the COPD patients had poor knowledge regarding self-management of COPD. These findings were consistent with Sharma et al. (2016) who reported that most of the COPD patients had less knowledge regarding COPD. Additionally, Mohamed et al. (2017) reported that none of the studied group had satisfactory knowledge at preintervention. Postimplementation of the educational program, the study findings showed that there was a highly statistically significant improvement in total score of knowledge, where most of the patients had a fair knowledge regarding COPD. This result was congruent with previous studies done by Cleary and Serisier (2012), Salah et al. (2013), and Sharma et al. (2016) who found a highly statistically significant improvement in all items of knowledge postintervention, reflecting the positive effect of the educational program, and the need for its application for COPD patients.

As regard patients’ level of practice preimplementation of the educational program, the studied group had unsatisfied practice regarding self-management skills for COPD. This may be due to the unfamiliarity of patients with this type of management. This result was in accordance with El-Gendy et al. (2015) who showed that only 10% of COPD patients had a satisfactory level of self-care practices. After intervention, the study showed the presence of statistically significant improvement in total score practice, where the majority of patients had satisfied and good practices at immediate and 2 months postprogram. This might be attributed to the fact that the researchers continued following the patients to practice skills of management of COPD. In the same context, Salah et al. (2013) found that there was highly statistically significant improvement in all items of practice postimplementation of guidelines. This result was consistent with Ries et al. (2007) who mentioned that when the patients develop a management plan with their healthcare team and follows it they can live better with COPD.

Concerning the correlation between characteristics of the studied sample and their knowledge, the findings of this study revealed that there were highly statistically significant correlations among patients’ education, marital status and crowding index and their knowledge regarding COPD. Similarly, Subba and Subba (2014) reported that there was significant relation to the level of overall knowledge and the educational status of the respondents, types of patient, and family history of COPD. Also, De Queiroz et al. (2015) showed that there was association between COPD knowledge and level of education among the studied sample. In addition, the current data have shown that poor knowledge about the disease did not differ in relation to sex and age of the studied group. These findings were consistent with a study done in Brazil by De Queiroz et al. (2015) who reported that there were no correlations between patients’ knowledge and their sex and age. Similarly, Subba and Subba (2014) reported that there was no significant difference in COPD knowledge between men and women. As well, the current findings showed that there were no statistically significant correlations between patients’ demographic characteristics and their practice regarding COPD self-management at all the stages of program implementation. These findings were consistent with the findings of Sharma et al. (2016) that the patients’ education, occupation, income, religion, and duration of the disease were not significantly associated with their self-management practice regarding management of COPD.

The findings of this study reported that the educational program might have a positive impact on improvement of some clinical outcomes of COPD patients after intervention. This might be attributed to the short period of follow-up for the patients after intervention; also most of the patients had a low level of education which might affect their acquisition of knowledge and skills. In the same line, Liu et al. (2014) mentioned that the rehabilitation program had positive improvement on COPD patients’ pulmonary function. The findings of this study have shown that there was a positive improvement in cough and sputum. Similarly, Moriyama et al. (2013) pointed out that the development of self-management behavior had an effective outcome on the improvement of productive cough. Additionally, the present study showed that there were statistically significant differences between shortness of breathing at pretest, immediately, and after 2 months after implementation of the self-management program. These results were supported by Damaris (2012) and Mohamed et al. (2017), who reported that the self-management program had positive improvements on patients symptomatology especially on dyspnea and on the level of breathing.

The lab investigation for pulmonary function was very low at pretest, while after the intervention, it was unavailable to be repeated for patients. This result was consistent with the results of Moriyama et al. (2013) who stated that the medical care system in Japan was not doing sufficient pulmonary function for patients. Inconsistent to a study done in China, Liu et al. (2014) mentioned that there was improvement of COPD pulmonary function as FEV1, FEV1/FVC after home-based rehabilitation program. This result could not be compared with the current finding because the investigation was done only once. These results were supported with the researchers’ hypotheses that COPD patients exposed to the self-care management program will have higher total knowledge and practice scores than those who did not attend the program.

Conclusion and recommendation

Based on the study findings, it is concluded that the knowledge and practice regarding self-care management among COPD patients were unsatisfied before implementation of the program. Also, the majority of patients had different symptoms of the disease such as productive cough, shortness of breath and restlessness, and had low pulmonary function. The educational program significantly improved the knowledge and practice of COPD patients regarding self-care management, and in some patients’ clinical outcomes, especially productive cough and shortness of breath, but pulmonary function tests were not done after the program. So the education of patients regarding COPD and healthcare practice is very effective in improving their self-management skills. Therefore, the healthcare personnel should provide the health education for COPD patients on self-care to improve their knowledge which helps prevent complications and maintaining their life. Follow-up for those patients is also needed to sustain their self-management compliance.[31]

Financial support and sponsorship

Nil.Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Badway MS, Hamed AF, Yousef MA (2016). Prevalence of chronic obstructive pulmonary disease (COPD) in Qena governorate. Egypt J Chest Dis Tuberc 65:29–34.  Back to cited text no. 1
    
2.
Baghai-Ravary R, Quint J, Goldring J, Hurst J, Donaldson G, Wedzicha J (2009). Determinants and impact of fatigue in patients with chronic obstructive pulmonary disease. Respir Med 103:216–223.  Back to cited text no. 2
    
3.
Barnes PJ (2008). Immunology of asthma and chronic obstructive pulmonary disease. Nat Rev Immunol 8:183–192.  Back to cited text no. 3
    
4.
Bourbeau J, van der Palen J (2009). Promoting effective self-management programs to improve COPD. Eur Respir J 33:461–463.  Back to cited text no. 4
    
5.
Chan-Yeung M, Ait N, White N, IP M, Tan WC (2004). The burden and impact of COPD in Asia and Africa. Int J Tuberc Lung 2004; 8:2–14.  Back to cited text no. 5
    
6.
Cleary M, Serisier D (2012). Better Living with Chronic Obstructive Pulmonary Disease: a patients with chronic obstructive pulmonary disease: guide. 2nd ed. Queensland: Queensland Health and Energy Conservation and Techniques.  Back to cited text no. 6
    
7.
Damaris A (2012). Respiratory rehabilitation in chronic obstructive bronchopneumonia [PhD thesis]. Romania: University of Medicine and Pharmacy of Craiova Faculty of Medicine; 1–19.  Back to cited text no. 7
    
8.
De Queiroz MC, Moreira MA, Rjardim J, Barbosa MA, Ruth Minamisava R, Heicilainy Del Carlos Gondim HD et al. (2015). Knowledge about COPD among users of primary health care services. Int J COPD 10:1–6.  Back to cited text no. 8
    
9.
Eisner MD, Anthonisen N, Coultas D, Kuenzl N, Perez-Padilla R, Postma D et al. (2010). An Official American Thoracic Society Public Policy Statement: novel risk factors and the global burden of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 182:693–718.  Back to cited text no. 9
    
10.
El-Gendy SR, Elsayed E, Alsaif A, Devreux I, Aboeleneen A, Darwesh A (2015). Awareness of patients with chronic obstructive pulmonary disease with dyspnea and fatigue self-management guidelines. Middle East J Sci Res 23:01–06.  Back to cited text no. 10
    
11.
Feenstra TL, van Genugten ML, Hoogenveen RT, Wouters EF, Rutten-van Molken MP. (2001). The impact of aging and smoking on the future burden of chronic obstructive pulmonary disease: a model analysis in the Netherlands. Am J Respir Crit Care Med 164:590–596.  Back to cited text no. 11
    
12.
Global Initiative for Chronic Obstructive Lung Disease (GOLD) (2010). Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease (updated 2015).  Back to cited text no. 12
    
13.
Korff MV, Gruman J, Schaefer SJ, Wagner CEH (1997). Collaborative management of chronic illness. Ann Intern Med 127:1097–1102.  Back to cited text no. 13
    
14.
Leiva-Fernández J, Leiva-Fernández F, García-Ruiz A, Prados-Torres D, Barnestein-Fonseca P (2014). Efficacy of a multifactorial intervention on therapeutic adherence in patients with chronic obstructive pulmonary disease (COPD): a randomized controlled trial. BMC Pulm Med 14:2–12.  Back to cited text no. 14
    
15.
Liu XL, Tan JY, Wang T, Zhang Q, Zhang M, Yao LQ et al. (2014). Effectiveness of home-based pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials. Rehabil Nurs 39:36–59.  Back to cited text no. 15
    
16.
Mohamed DM, Ahmed SS, Mohamed AH, Abdel Rahman AA (2017). Effect of care protocol on the knowledge, practice and clinical outcomes of patients with chronic obstructive pulmonary disease. J Nurs Educ Pract 7:108–116.  Back to cited text no. 16
    
17.
Moriyama M, Takeshita Y, Haruta1 Y, Hattori N, Ezenwaka CE (2013). Effects of a 6-month nurse-led self-management program on comprehensive pulmonary rehabilitation for patients with COPD receiving home oxygen therapy. Rehabil Nurs 0:1–12.  Back to cited text no. 17
    
18.
National Center for Health Statistics (2015). Healthy People 2020. Available at: http://www.cdc.gov/nchs/fastats/lcod.htm  Back to cited text no. 18
    
19.
National Heart, Lung and Blood Institute (2018). COPD. Available at: https://www.nhlbi.nih.gov/health-topics/copd  Back to cited text no. 19
    
20.
Nishiyama O, Taniguchi H, Kondoh Y, Kimura T, Kato K, Kataoka K et al. (2010). A simple assessment of dyspnea as a prognostic indicator in idiopathic pulmonary fibrosis. Eur Respir J 36:1067–1072.  Back to cited text no. 20
    
21.
Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calveriey P et al. (2007). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 176:532–555.  Back to cited text no. 21
    
22.
Reardon JZ, Lareau SC, ZuWallack R (2006). Functional status and quality of life in chronic obstructive pulmonary disease. Am J Med 119:32–37.  Back to cited text no. 22
    
23.
Ries A, Bauldoff G, Carlin B, Casabur R, Emery C, Mahler D et al. (2007). Pulmonary rehabilitation: joint ACCP/AACVPR. Evidence based clinical practice guidelines. Chest 131:4S–42S.  Back to cited text no. 23
    
24.
Said AF, Ewis AA, Omran AA, Magdy ME, Saleeb MF (2015). Prevalence and predictors of chronic obstructive pulmonary disease among high-risk Egyptians. Egypt J Bronchol 9:27–33.  Back to cited text no. 24
    
25.
Salah M, Hamdi A, Shehata H (2013). Improving breathlessness and fatigue in patient with copd. J Am Sci 9:470–482.  Back to cited text no. 25
    
26.
Sharma MK, Atul Kumar A, Venkateshan M (2016). Effectiveness of self-instructional module on knowledge of self-care management of chronic obstructive pulmonary disease among patients with chronic obstructive pulmonary disease. Int J Res Med Sci 4:1604–1608.  Back to cited text no. 26
    
27.
Subba HK, Subba R (2014). Knowledge on self care among COPD patients attending at Chitwan Medical College, Teaching Hospital, Bharatpur. J Chitwan Med Coll 4:34–37.  Back to cited text no. 27
    
28.
Tel H, Bilgiç Z, Zorlu Z (2012). Evaluation of Dyspnea and Fatigue Among the COPDPatients, Chronic Obstructive Pulmonary Disease - Current Concepts and Practice, Dr. Kian-Chung Ong (Ed.), ISBN: 978-953-51-0163-5, InTech, Available from: http://www.intechopen.com/books/chronic-obstructivepulmonary-disease-current-concepts-and-practice/evaluation-of-dyspnea-and-fatigue-among-the-copdpatients  Back to cited text no. 28
    
29.
Toraldo DM, Nuccio FD, Scoditti E (2013). Systemic inflammation in chronic obstructive pulmonary disease: may diet play a therapeutic role. J Aller Ther S2:005.  Back to cited text no. 29
    
30.
Vestbo J, Hurd SS, Agusti AG, Jones PW, Vogelmeier C, Anzueto A et al. (2013). Global strategy for diagnosis management, and prevention of COPD. Am J Respir Crit Care Med 87:347–365.  Back to cited text no. 30
    
31.
WHO (2008) WHO report on the global tobacco epidemic 2008: the MPOWER package (PDF) (ISBN 92-4-159628-7). Geneva: World Health Organization.  Back to cited text no. 31
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]



 

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