What motivates patients with COPD to engage in behaviour change? A longitudinal qualitative study of telephone health coaching
Self-management is critical to improving health outcomes among people with long term conditions (LTCs). Telephone health coaching has emerged as a leading candidate intervention to promote self-management via behaviour change in people with LTCs. Evidence of effectiveness is mixed however, with uncertainty about whether such an approach has applications for people with mild disease who may not prioritise behaviour change. Our aim was to explore what motivated patients with mildly symptomatic COPD to engage with a nurse-led telephone health coaching intervention that targeted physical activity, smoking cessation, medication management and action planning for acute exacerbations. We also explored the acceptability and feasibility of the intervention with a view to informing scale up beyond the trial setting.
Semi structured in-depth interviews with 21 participants who were randomised to receive telephone health coaching. Participants were identified from general practice COPD registers. Diagnosis of COPD was confirmed by post bronchodilator spirometry and self-reported mild dyspnoea (MRC grades 1 or 2). Interviews took place approximately six and 12 months post randomisation. Interviews were transcribed and then analysed using a framework approach.
Twenty one interviews were conducted; 20 (95%) completed a second interview six months later. Most participants engaged in behaviour change that focused on increasing physical activity, often facilitated through the use of a pedometer to self-monitor. Participants’ motivations focused on preventing physical deterioration and signalled a commitment to protect future health but this reasoning was often articulated in the context of receiving positive feedback from the nurse. Few participants enjoyed or wanted to set formal goals about physical activity. Instead they preferred to adopt a more flexible approach that allowed them to make small adjustments to existing routines that fit with other aspects of their life. Follow up interviews revealed that the majority of participants had maintained improvements in physical activity and routinely used the pedometer to self-monitor activity. Those who had not maintained changes to physical activity routines cited contextual factors such as changes in health, especially increased breathlessness, or social problems in the family as key barriers. Seasonal changes in the weather were also commonly identified as a barrier to maintaining activity routines.
Participants with mildly symptomatic COPD were able to make and maintain positive changes to health behaviours following telephone health coaching. While change was partly driven by intrinsic motivations to protect future health it was also contingent on regular feedback from the nurse and self-monitoring. Maintaining behaviour change was more challenging. A more tailored and individual approach might overcome barriers to goal setting while addressing social and environmental factors might help support lasting behaviour change.