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Abstract
Background
The existing models of care developed to comprehensively address the needs of people with multimorbid chronic obstructive pulmonary disease (COPD) may not be directly applicable to low- and middle-income countries (LMICs) like Nepal. Therefore, this research sought to co-design, with end-users and stakeholders, an integrated model of care to deliver a comprehensive self-management intervention to people with multimorbid COPD in rural Nepal.
Methods
This research was conducted in two stages: i) a parallel mixed-method descriptive research to understand self-management practices (SMPs), health literacy (HL) and patient activation (PA), along with their barriers and facilitators; and ii) Evaluation of the feasibility and acceptability of a co-design process used to develop a model of care. The descriptive research included a survey of 238 people with multimorbid COPD and qualitative explorations using in-depth interviews (IDIs) of selected stakeholders. The evaluation included qualitative analysis of IDIs, video recordings from co-design workshops and observation notes. Data were collected between September 2018 and December 2019 in the Sunsari district, Nepal.
Results
More than two-thirds of participants had low levels of SMPs and HL and were less activated. Qualitative exploration identified inadequate family support, inadequate infrastructure and resources at primary care, limited skills of primary level providers and lack of educational materials for COPD, as barriers for SMPs. These findings guided the ideation of an integrated model of care, which was later refined in the prototype stage. This model of care included screening the community for people with COPD and morbidities within primary health care, establishing referral pathways and establishing a community-based support system. Evaluation of the co-design process showed that the approach was well accepted and feasible. A co-design evaluation framework was developed.
Conclusion
The descriptive research findings suggest that SMPs, HL and PA among the participants were low and had several barriers that an integrated model could address. The evaluation of the co-design approach revealed that the co-design process was feasible and acceptable to end-users and government agencies in Nepal. This has important practice, policy and research implications for the application of co-design in LMICs and for delivering self-management intervention targeting people with multimorbid COPD in Nepal or settings of similar context.