Date of Award

January 2018

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Linda L. Shanta


Introduction: Self-management plays a central role in the treatment chronic obstructive pulmonary disease (COPD). However, the patient characteristics necessary for effective self-management are not understood. The skills, confidence, and knowledge to engage in chronic disease self-care, known as patient activation, may play a key role in the capacity of people to self-manage COPD. How the complex, systemic nature of COPD influences patient activation has not been explored. Therefore, the purpose of this study was to examine the relationships among patient characteristics and health outcomes as determinants of patient activation among community-dwelling adults in the U.S. with COPD. The Revised Wilson Cleary Model (Ferrans, Zerwic, Wilbur & Larson, 2005) was adapted to examine a continuum of integrated variables integral to the experience of COPD for this descriptive correlational survey study.

Methods: A random sample of 64 community-dwelling adults with COPD completed a self-report postal survey. The questionnaire was comprised of demographic questions and the Positive Affect Negative Affect Schedule, to measure individual and environmental patient characteristics, and the Quality of Life Index Pulmonary Version III, Pulmonary Functional Status and Dyspnea Questionnaire-Modified, a single question to assess general perception of health, and the Patient Activation Measure-13 (PAM) to assess health outcomes. Additionally, spirometry data was abstracted from participants’ medical records. Descriptive and univariate statistics were utilized to describe and examine the unadjusted associations between patient characteristics, health outcomes and patient activation scores. Variables significantly (p < .25) associated with patient activation were entered into stepwise multivariate regression models to identify independent predictors of patient activation in the sample.

Results: The participants in the study were mostly men and women in their 70s with moderate to severe COPD, having lived with the disease for over four years. The patient activation scores were high among the sample (M = 66, SD = 16), with over 70% of the sample activated at PAM Level 3 and 4 (n = 47, 73%). Univariate analyses revealed significant relationships between several patient characteristics (gender, positive affect, lower Body Mass Index, education level, time since diagnosis of COPD, smoking pack years, urban residence) and patient activation. Health outcome domains, such as low fatigue, good or very good general perception of health, and better perceived overall quality of life) were directly related to patient activation in the sample. The resulting statistically significant regression model (R2 = .488, Adj.R2 = .454, p < .001) contained four independent predictors explaining 45% of the variation in patient activation in the sample. Positive affect β = .457 contributed most to the model, followed by smoking pack years β = .345, overall quality of life β = .264, and female gender β = -.192.

Conclusions: Several patient characteristics and complex health outcomes underlie self-management capacity in COPD. This study revealed novel determinants of patient activation that have implications for COPD self-management science and nursing practice. Nurses are in a pivotal position to apply knowledge of patient activation to the individualized assessment and care interventions of people living with COPD. Further research is needed to explicate the unique psychosocial factors that contribute to capacity to self-manage for targeted intervention design in this population.