Patient and provider perspectives of a self-management program for COPD in the context of multimorbidity: a qualitative study

Background: Chronic obstructive pulmonary disease (COPD) is often associated with comorbidities, which further complicates the impact of the disease. However, most self-management support for COPD do not account for patients' comorbidities. This study is the qualitative evaluation of a novel self-management program for people with COPD in the context of multimorbidity, delivered by practice nurses (PNs) in collaboration with general practitioners (GPs) in Sydney, Australia. Methods: Semi-structured interviews were conducted with 12 patients, 10 PNs, and seven GPs. The interviews were thematically analysed using a constructivist approach, and further interpreted through the Normalisation Process Theory. Results: Most patients accepted the program and perceived it as beneficial. Facilitators towards better activation were personalised care and the PNs' counselling approach during the program. Barriers to better health behaviour included personal challenges and comorbidities. Overall, the PNs and GPs found the program to be feasible and beneficial for participating patients. The PNs felt upskilled about COPD, and confident for delivering self-management support, following participation in the study. The main challenge faced by them were managing their existing workload alongside the education sessions. Conclusions: The findings emphasise the need for tailored, self-management support for people with COPD and comorbidities, and upskilling of the PN's role in general practice.