Understanding COPD Exacerbations: A Qualitative Study

International Journal Medicine Public Health

Overview of research design

Discuss About The International Journal Medicine Public Health.

Earlier studies state that patients expressed difficulty in understanding term COPD exacerbations. In earlier studies, it was mentioned that clinical markers were used by the patients for the identification of the exacerbations. Patients contacted healthcare providers based on the identified symptoms. There was lack of experimental knowledge like visible and invisible symptoms for identification of COPD exacerbations. It was difficult for the patients to distinguish between the bad day and COPD exacerbations (Polastri, Pisani, Dell’Amore et al., 2017; Brien et al., 2018). Outcome of the current study revealed that patient can distinguish between bad day and COPD exacerbations.

1. What is the significance of this study?

In this study patient’s knowledge and understanding of the COPD was being assessed. COPD knowledge among the patients can be helpful in early identification of the disease. Hence, early plan can be implemented for providing intervention for prevention and treatment of COPD. Patients learned to verbalize both subjective and objective symptoms of COPD.

1. What was the aim of the research?

Main aim of this study is to explore patients’ current understanding and experience in managing and identifying COPD exacerbations at home.

1. What research design was used?

1. Describe the main characteristics of the research design identified.

Interview based qualitative study design mainly based on the sampling of the participants. Main emphasis of the interview based qualitative study design should be participants because outcome of this study design mainly based on the participants. Participants need to express their feelings and experiences. Content of the interview questions are very important aspects because outcome of the study mainly based on the interview questions. Semi-structured interviews of the recruited participants were carried out in this study (Morris, 2015; Bell, 2014).

1. How did the research design chosen meet the aim(s) of the study?

Questions incorporated in the interview process of this study include patient’s understanding and knowledge about identification of the COPD symptoms, patient’s experiences and patient’s self-management strategy. Answers provided by the patients can be helpful in understanding patient’s ability to recognise and manage COPD. Hence, this research design can be helpful to meet the aim of the study. Hence, this interview based qualitative study can be helpful to meet the aim of the study. 

1. What were the characteristics of the participants in this study ?

27 male and 17 female participants were recruited in this study. Average age of these recruited participants was 71 years and its range were between 55 – 85 years. GLOD stated that COPD can be categorised into different classes based on the its severity. Following number of patients were recruited with different stages of COPD : GOLD stage II, GOLD stage III and GOD stage IV with 14, 21 and 9 patients respectively. COPD symptoms were there in these patients since 1 – 25 years. 15 patients were living alone and 29 patients were living with their spouse or other family members.

1. What were the inclusion and exclusion criteria of the sample ?

Sampling

Following are the inclusion and exclusion criteria for participants in the study. Age ?40 years. A forced expiratory volume in 1s (FEV1) post-bronchodilator ?80% and predicted ratio of FEV1 to forced vital capacity (FVC) ?0.70. Smoking history ?10 pack years.  MRC dyspnoea scale ?2. Registered with a general practice and with an exacerbation of COPD requiring home treatment or hospital admission in the previous year or referred for pulmonary rehabilitation. Absence of other signi?cant lung disease. Absence of chronic heart failure de?ned by the New York Heart Association classi?cation system as severe (Grade IV). Able to give informed consent. Life expectancy of 43 months. Able to adequately understand written and verbal English.

1. Why is it important to identify these criteria before recruitment starts ?

Incorporating inclusion and exclusion criteria in sample selection can be helpful in defining sample universe. It can also be helpful in decision making of the sample selection. Patient characteristics can be effectively identified by incorporating inclusion and exclusion criteria in the sample selection. Severity of the disease, exposure to potential risk factors and association with co-morbid condition can be identified through these inclusion and exclusion criteria. Robust and valid output of the research study can be achieved by considering these criteria prior to initiation of the study. It can also be helpful in reducing variability in the outcome among recruited participants (Isaacs, 2014; Braun et al., 2014).

1. What sampling technique was used in this study?

In this study, patients were recruited from the various sources like hospital admission records, pulmonary rehabilitation programmes and general practice.

1. How was this sample appropriate for meeting the research aim?

Aim of the study is to understand the patient’s knowledge about the COPD. Participants recruited in this study were associated with COPD. Hence, knowledge among the patients about COPD can be collected from these patients. Since, recruited participants can provide their understanding and knowledge about the COPD, this sample can be helpful in meeting aim of the study.

1. How were the data collected?

1. What, specifically, did the researchers do?

Experienced researchers were being involved in the data collection; hence collected data could be considered as the robust data. Investigator associated with the interview-based data collection received extensive training for qualitative research. Semi-structured type of questions were designed for this study and mentioned questions were specific to the aim of the study. These questions were related to the patient’s experience, knowledge, ability to recognise and manage COPD. For each of the recruited participants, interview lasted for about 20 to 55 minutes. Whole interview procedure was audio-recorded. These audio-records could be helpful in providing more insight of the interview, accurate analysis and monitoring of the interview process. Spouses and family members of six of the participants were available during interview process because these participants were not comfortable in verbalising and expressing their experiences about COPD condition (Levickis et al., 2013). 

1. How did data collection fit the aims of this study?

Data collection

Data was collected in this study by asking questions related to the recognition of the COPD symptoms and its management. Data related to the patent’s knowledge about COPD was collected through interview questions. As a result, data collection fits aim of the study.

1. What might have been some advantages and disadvantages of this method of data collection?

Accurate data related to the screening and outcome of the study can be collected because participants being interviewed can not give false information related to age and gender. In this type of data collection, both verbal and non-verbal ques can be obtained from the participants. Hence, level of knowledge and comfort level in expressing knowledge can be easily assessed. Distractions can be easily avoided and specific focus can be given to the data collection during the interview process. Emotions and behaviour of the patients can be assessed during the interview process.

High cost can be major constraint for the home-based interviews because interviewer is required to visit each patient’s home for conducting interview. Sample recruitment need to be kept in limit because for more number of sample; more number of interviewers need to be recruited. In this study, sample size was less because only one interviewer was incorporated (Morris, 2015; Erlingsson & Brysiewicz, 2013). 

1. From your understanding of the weekly readings, what if any, are some alternative methods of data collection that these researchers could have chosen?

In qualitative research, interview-based data collection can be considered as the most widely used and valid method for data collection. However, other methods like observations and textual or visual analysis (eg from books or videos) could have been used in the data collection  (Morris, 2015; Dean et al., 2016).

1. How was the data analysed?

Collected data was analysed by incorporating multiple steps. Prior to analysis, collected data was stored and organised. Audio-recorded data were transcribed into the verbatim and anonymised transcripts were imported into the NVIVO 10 (qualitative software data programme). Data analysis was performed by grounded theory approach and constant comparative method. Open, axial and selective coding was implemented in the data analysis to eliminate bias in the outcome of the study.

1. Why is it important to select applicable methods of data analysis in qualitative research?

It is important to select these methods in the data collection because data was collected through questions and collected data was analysed (Morris, 2015; Fisher, 2011).

1. What did the researchers say about the rigour of their analysis?

Rigour or validity of the outcome and study was improved by implementing coding system to data. Moreover, coding was done by experienced researcher who was not part of the study. Memo-writing was implemented in the effective analysis of the data. Theoretical links and concepts from the collected data were being recognised through memo-writing. Analysis and interpretation of the collected data was being carried out through extensive discussion among experienced researchers. Transparency of the study and collected data was improved by coding and subsequent elimination of bias in the study. Credibility of the outcome of the study was improved by involving experienced researchers and discussion among them on regular basis (Bloomer et al., 2013).

1. What were the study findings?

Advantages and disadvantages of interview-based data collection

Patients were become capable of identifying COPD exacerbation through visible symptoms associated with the clinical parameters and invisible symptoms associated with the experimental knowledge. Signs and symptoms of exacerbations were identified by the patients with past history of COPD exacerbations. These patients also recognised time of COPD exacerbations. Patients also acquired and understood self-management techniques like breathing techniques. Patients understood aim of administering antibiotic and steroid administration. Patient’s mentioned that they can recognise and monitor COPD exacerbations and ask for help from healthcare providers for receiving quality intervention. It can be helpful in reducing further deterioration of the patient. Findings of this were in align with the aim of the study because patient were able to recognise symptoms of the COPD.

1. Into which other settings can these findings be transferred

Findings from this qualitative research can be transferred to other long-term facilities like diabetes and obesity care because in these healthcare facilities also visible and invisible symptoms can be identified through experimental knowledge (Harreveld et al., 2016).

References:

Bell, E. (2014). Rethinking quality in qualitative research. Australian Journal of Rural Health, 22(3), 90-1.

Bloomer, M.J., Doman, M., and Endacott, R. (2013). How the observed create ethical dilemmas for the observers: experiences from studies conducted in clinical settings in the UK and Australia. Nursing & Health Sciences, 15(4), 410-4.

Braun, K.L., Browne, C.V., Ka’opua, L.S., Kim, B.J., and Mokuau, N. (2014). Research on indigenous elders: from positivistic to decolonizing methodologies. Gerontologist, 54(1), 117-26.

Dickens, A.P, Kendrick, T., Jordan, R.E., Adab, P., and Thomas, M. (2018). Independent determinants of disease-related quality of life in COPD – scope for nonpharmacologic interventions? International Journal of Chronic Obstructive Pulmonary Disease,  13, 247-256.

Dean, W., Sophie, D., & Isabel, H. (2016). Common qualitative methods. In Z. Schneider, D. Whitehead, G. LoBiondo-Wood & J. Haber (Eds.), Nursing and midwifery research: Methods and appraisal for evidence based practice (5^th ed., pp. 93 – 109). Chastwood : Elsevier Australia.

Erlingsson, C., & Brysiewicz, P. (2013). Orientation among multiple truths : An introduction to qualitative research. African Journal of Emergency Medicine, 3(2), 92 – 99.

Fisher, K. (2011). The qualitative interview and challenges for clinicians undertaking research: a personal reflection. Australian Journal of Primary Health, 17(1), 102-6.

Harreveld, B., Danaher, M., Celeste, L., Knight, BA., and Busch, G. (2016). Constructing Methodology for Qualitative Research: Researching Education and Social Practice. Springer.

Isaacs, A. (2014). An overview of qualitative research methodology for public health researchers. International Journal of Medicine and Public Health, 4(4), 318.

Levickis, P., Naughton, G., Gerner, B., and Gibbons, K. (2013). Why families choose not to participate in research: feedback from non-responders. Journal of Paediatrics and Child Health, 49(1), 57-62.

Morris, A. (2015).  A Practical Introduction to In-depth Interviewing. SAGE.

Polastri, M., Pisani, L., Dell’Amore, A., and Nava, S. (2017). Revolving door respiratory patients: A rehabilitative perspective. Monaldi Archives for Chest Disease, 87(3):857.

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