Patient Education and Counseling 55 (2004) 168–176 Self-care issues from the perspective of individuals with Chronic Obstructive Pulmonary Disease Lisa Cicutto a,* , Dina Brooks b , Katy Henderson b a Faculty of Nursing, University of Toronto, 50 St. George Street, Toronto, Ont., Canada M5S 3H4 b Department of Physical Therapy, Faculty of Medicine, University of Toronto, 500 University Ave, 8th Flr, Toronto, Ont., Canada M5G 1V7 Received 23 December 2002; received in revised form 20 August 2003; accepted 26 August 2003 Abstract This study explored factors that influence self-care from the perspective of individuals with Chronic Obstructive Pulmonary Disease (COPD). Seven focus groups were held with individuals who had physician diagnosed COPD and experienced daily symptoms that limited activities. Forty-two subjects participated in the study. All sessions were audiotaped, transcribed and coded independently. The main theme identified was surviving COPD: the context for living and the two sub-themes identified were adjusting physically and emotionally to COPD. Participants discussed their self-care practices within the context of the purpose and meaning of life. Although participants experienced major physical limitations, the issues highlighted were those of individuals striving to survive with COPD and to hold on to some quality of life through adjusting physically and emotionally. Individuals with COPD have developed strategies to adapt to the disease, compensate for limitations, and integrate self-care activities for managing COPD into their daily routine. Health professionals should use approaches that support the whole needs of the individual to achieve the best quality of life for individuals with COPD and their families. © 2003 Elsevier Ireland Ltd. All rights reserved. Keywords: Chronic Obstructive Pulmonary Disease; Self-care; Focus groups 1. Introduction Chronic Obstructive Pulmonary Disease (COPD) is char- acterized by airflow obstruction due to chronic bronchitis and/or emphysema [1,2]. COPD is the fourth leading cause of death in men in Canada and the seventh leading cause of death in women [3]. Among the five most common dis- eases, COPD is the only disease continuing to demonstrate increasing morbidity and mortality rates [4]. International evidence-based guidelines summarize the goals for managing COPD as prevention of disease progres- sion, relief of symptoms, improvement of exercise tolerance and health status, prevention and treatment of compli- cations, prevention and treatment of exacerbations, and reduction of mortality [5]. A comprehensive approach to managing COPD includes several components: prevention, medical management and rehabilitation. Primary preven- tion takes the form of smoking cessation and immunization programs. Medical management of both chronic and acute * Corresponding author. Tel.: +1-416-978-6059; fax: +1-416-978-8222. E-mail address: lisa.cicutto@utoronto.ca (L. Cicutto). phases of illness, including the treatment of co-morbid con- ditions, may consist of pharmacotherapy, ventilatory sup- port, long-term oxygen use, and nutritional interventions. Pulmonary rehabilitation is directed at improving quality of life and functional capacity and includes patient education and exercises, both aerobic and nonaerobic. The terms self-care or self-management denote any self-initiated, self-directed action of engaging in activities of daily living and other activities to preserve physical, emotional and social wellness [6]. This term emphasizes the patient’s role as primary in his/her health care. Worth [7] has defined self-management related to COPD as the active participation of the patient in the treatment of the dis- ease based on sufficient coping behavior, compliance with inhaled medication, attention to changes in the severity of the disease, and adequate inhalation technique. Understanding behaviors related to the self-management of a disease is complex and for the most part represents a “black box” for health care professionals. Yet, it may be key to optimizing health. Several factors may influence self-care behaviors such as patient factors (e.g. emotional state), clinician factors (e.g. communication style), health program factors (e.g. complexity of the program) and 0738-3991/$ – see front matter © 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.pec.2003.08.012