An Application Of Protection Motivation Theory To Self-management Of Patients With Chronic Obstructive Pulmonary Disease

Objectives:To investigate the present situation of management behavior among patients with Chronic Obstructive Pulmonary Disease. To analyze the influential factors associated with self-management behavior and self-management behavior intentions based on protection motivation theory.Methods:A total of 346 patients were recruited by convenient sampling in two top-ranked general hospitals from December 2014 to July 2015 in Liaocheng City. We used sociodemographic and clinical questionnaire, Chronic Obstructive Pulmonary Disease Knowledge Questionnaire (COPD-Q), Protective motivation factor and Protective motivation questionnaire,and Self-management Scale(SMS). Statistical analysis was conducted using SPSS 13.0. Descriptive analysis,t test, F test, Pearson correlation analysis and multivariate linear regression were used to identify the predictors of self-management behavior and self-management behavior intentions..Results1.The average score of COPD Patients Self-Management Behavior Rang Scale was 2.82±0.53. The level of mood management was the highest, followed by daily life management, symptom management and information management. The score of self-management intentions among patients with COPD ranged from 13 to 35, with an average of (28.05±4.49).2. The level of self-management significantly varied by age, gender, marriage, education, income, living arrangement, residence, pulmonary function, and hospitalization history. Self-management intentions differed by residence, living arrangement and pulmonary function.3. Response costs were not significantly correlated with self-management and intentions to self-manage, respectively (r=0.022, r=0.101, P> 0.05). Self-management was moderately correlated with self-efficacy (r=0.622, P<0.01), but modestly with other variables of PMT (r=0.144-0.387, P<0.01). Intentions to self-manage was moderately correlated with perceived severity, vulnerability, response efficacy, and threat(r=0.587-0.646, P<0.01), but not significantly correlated with self-efficacy (r=0.076, P>0.05).4. Multivariate regression analyses showed that the constructed model explained 60.8%and 61.1% of the variance in self-management and intentions to self-manage. Wherein, the variables of PMT accounted for 25.2% of the variance of self-management and 42.7% of intentions to self-manage, respectively. The significant predictors of self-management included self-efficacy (β=0.563, P<0.001), intentions to self-management (β=0.232, P<0.001), COPD knowledge (β=0.197, P<0.001), perceived vulnerability(β=0.159, P<0.05). The significant predictors of intentions to self-manage included perceived threat (β=0.291, P<0.001), response efficacy (β=0.263, P<0.001), perceived severity (β=0.240, P<0.001), COPD knowledge (β=0.111, P<0.01).Conclusions1. The self-management behavior of patients with COPD in Liaocheng City is at a moderate level.2. The level of self-management is higher among male married COPD patients with older age, higher education and income, better pulmonary function and hospitalization history, living with families in city. The level of intentions to self-manage is stronger among COPD patients with better pulmonary function and living with families in city.3. The protective motivation related factors except response costs positively correlate with self-management and intentions to self-manage among COPD patients, while the magnitudes of correlation differ.4. The protection motivation theory can well explain and forecast the self-management and intentions to self-manage among COPD patients. The main cognitive predictor is self efficacy for self-management, while threat, response efficacy, and perceived severity for intentions to self-manage.