To act, or not to act – a sense of control is important for people with COPD. A Grounded Theory Study. (Preprint)
Authors: Marklund Sarah , Sörlin Ann , Stenlund Tobias , Wadell Karin , Nyberg Andre 
Published: June 2022

BACKGROUND

Among people with chronic obstructive pulmonary disease (COPD), low levels of daily physical activity (PA) are the main risk factors for developing cardiovascular, metabolic, and musculoskeletal comorbidities. Increasing PA in people with COPD is as complex as PA behavior is complex and multi-faceted, including personal, physiological, and psychological elements as well as social and environmental factors. Even though electronic health (eHealth) solutions such as web-based support or interactive websites have shown positive effects on PA in people with COPD, results are inconclusive and it is still unclear how eHealth solutions might be used to support positive change in PA behavior in people with COPD.

OBJECTIVE

The study aimed to explore the perceptions of increasing objective PA when using a web-based eHealth tool among people with COPD.

METHODS

The current study was part of a pragmatic randomized controlled trial (RCT), with in-depth interviews between the 3- and 12-month follow-ups. The methodology used was constructivist Grounded Theory. All sampling included RCT intervention group participants who had access to the eHealth tool in question and accepted being contacted regarding an in-depth interview. Inclusion of participants continued until data saturation was reached, resulting in an inclusion of 14 participants (8 women) between the ages of 49 to 84, living in eight municipalities in the Middle and Northern Sweden. Two interviews were conducted face-to-face, and the rest of the interviews were conducted via telephone. All of the interviews were recorded using a Dictaphone.

RESULTS

The analysis resulted in three main categories, Welcoming or not welcoming action, Having or lacking resources, and Lowering the threshold. The first two contain barriers and facilitators, while the third contains only facilitators. The categories lead to the more latent theme of Perceiving enough control to enable action, meaning that it seems that perceiving the “right” amount of control is essential to maintain or increase the level of PA when using an eHealth tool among patients with COPD. However, what the right amount of control was seemed to depend on the individual (and context) in question.

CONCLUSIONS

The core category indicates that a need for a certain sense of control was interpreted as necessary for increasing the PA level as well as for using an eHealth tool to help increase the PA level. The eHealth tool seemed to strengthen or weaken the perception of control by either providing support or being too demanding on the user. Perceptions varied depending on other factors in the environment. The Fogg Behavior Model illustrated how motivational levels, ability levels, and functional triggers interact within our findings. Thus, this study shows further evidence for the importance of empowering the patients to boost their level of agency and their ability to improve PA levels.

CLINICALTRIAL

ClinicalTrials.gov identifier: NCT03746873.
Ethical approval was given by the Regional Ethical Board, Umeå University, Umeå, Sweden (Dnr: 2018-274-31 plus amendment Dnr: 2019-05572).

INTERNATIONAL REGISTERED REPORT

RR2-10.1136/bmjopen-2019-030788