الفهرس 
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Abstract
Chronic obstructive pulmonary disease (COPD) is a serious health problem, as it is one of the major causes of death worldwide and negatively impacts patients’ health status. from 40% to 50% of patients with COPD discharged from hospitals are readmitted during the following year (Rooddehghan, 2018). COPD is a common, preventable, and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities, usually caused by significant exposure to noxious particles or gases (Vogelmeier et al., 2017).
Self-care management for patients with COPD is complex and challenging, requiring patients to manage various facets of their condition, including understanding and taking their medications appropriately with good inhaler technique, early recognition of exacerbations of symptoms and early instigation of treatment during an exacerbation, receiving annual influenza vaccinations, managing their breathlessness to allow them to undertake activities of daily living, bronchial clearance techniques, taking regular exercise to maintain their lung function and exercise capacity, quitting smoking, and maintaining a healthy diet (Chen & Yao, 2018).
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Intervention program are the most common strategies for compliance to self-care management that might be as simple as provision of written material alone, instruction or demonstration in inhalation techniques, or as complex as a training program or structured program including provision of comprehensive information on disease pathology, treatment plan, medication, and self-management with action plan (Lenferink et al., 2017).
Community health nurse (CHN) can improve the health status of their patients and avert unnecessary COPD-related readmissions and life-threatening exacerbations using techniques that allow quick recognition of the triggers and symptoms of exacerbations (Liang, Abramson, & George, 2017).
Aim of the Study
The aim of this study was to evaluate the effect of intervention program for adult patients with chronic obstructive pulmonary disease on their knowledge and practices regarding compliance to self-care management through:
1- Assessing health status of adult patients with chronic obstructive pulmonary disease
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2- Assessing adult’s patients’ knowledge regarding chronic obstructive pulmonary disease.
3- Assessing adult’s patients’ practice regarding their compliance to self-care management of chronic obstructive pulmonary disease.
4- Designing and implementing intervention programs for adult patients with chronic obstructive pulmonary disease about their compliance to self-care management.
5- Evaluating the effects of intervention program for adult patients with chronic obstructive pulmonary disease on their knowledge and practices regarding compliance to self-care management.
Subject and Methods
Research design:
A Quasi-experimental research design was utilized to fulfill the aim of this study.
1-Technical Design:
Research Setting:
The study was conducted in the outpatient clinic of Menia Chest Hospital, Menia Governorate, Egypt.
Sample:
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A purposive sample had used for choosing the study sample, the total number of the study sample were (115) plus (12) for pilot study of adult patients with COPD. It was representing 10% of the yearly average, from the total (1155) patients with COPD attending the study setting in chest outpatient clinics of Menia Chest Hospital from 1/7/2018 to 30/6/2019.
Data collection tool:
Interviewing questionnaire had been used to conduct this study: Tool I:
Part I: Demographic data of the study sample.
Part II: Medical history of the studied sample.
Part III:
A- Assessment of the effect of COPD on adult patients’ activity of daily life of.
B- Assessment of the effect of COPD on adult patients’ health status
Part IV: Assessment of adult patients‘ knowledge about COPD
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Part V: Assessment of adult patients’ compliance to self-care management.
Part (VI): Assessment of adult patients’ practices regarding self-care management
Validity and Reliability:
Validity:
The tool of the study was given to a group of five experts in nursing community field. The tool was examined for content coverage, clarity, relevance, applicability, wording, length, format, and overall appearance. Based on experts` comments and recommendations; minor modifications had been made such as rephrasing and rearrangements of some sentences.
Reliability:
Internal consistency of interview questionnaire was assessed with the Cronbach’s alpha coefficient. Cronbach’s alpha coefficient of 0.00 indicates no reliability and a coefficient of 1.00 indicates perfect reliability. However, a reliability coefficient of 0.70 is acceptable.
II. Operational Design:
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The operational design included, pilot study, preparatory phase, implementation phase include fieldwork, methodology, limitations of the study and ethical considerations.
Pilot study:
A pilot study was carried out, 10% of the total subjects were recruited for the pilot study before conducting the actual study to determine the size and the method of selection of the sample, to test the feasibility, clarity and applicability of the study tool also to test relevancy and clarity of the content, to calculate the time needed for conducting the study and to estimate the needed time to be filled in the tool.
The Present study was conducting in four phase:
I. Preparatory phase:
A review of recent current national and international related literature in various aspects of the disease was applied at this phase to design the study tool and to be acquainted with various aspects of the disease.
II. Assessment phase:
It included assessment the level of the demographic characteristics, health history, adult’s patients’ knowledge regarding their disease, degree of compliance to self-care management through assessment tool.
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III. Planning and implementation phase:
A plan was formulated for each patient based on assessment phase and literature review, the researcher prepared the training places, teaching aids and media (picture, and handouts). A booklet as a teaching aid was prepared, and then revised by a group of expertise in community health nursing for the content validity.
IV. Theoretical part:
This had been implemented in 6 sessions, once a week and each session take about 1 hour. Each session included five to seven adult patients’ with COPD. The researcher started each session with summary of the previous one. An Arabic language with simple words had been used to suit the adult patients‘ level of understanding. At end of session the patient questions had been discussed.
V. Practical part:
This had been implemented in 2 sessions, in the last week after completion of the theoretical part and each session took about 1 hour.
VI. Evaluation phase:
The evaluation of the effectiveness the intervention program was carried after finishing the program using the pre-test questionnaire and the observation checklist.
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Result:
The study results can be summarized as follows:
Based on the findings of the present study, it can be concluded that, the most of most of the studied sample were independent in pre- intervention program comparing to the majority of them in post intervention program. Also the COPD had severe effect on the total health status of more than two fifths of the studied sample in pre intervention program comparing to less than one third of them in post intervention program. Also the current study clarified that, less than two thirds of the studied sample had unsatisfactory total knowledge of COPD, in pre intervention program, comparing to less than three quarters of them had satisfactory total knowledge regarding COPD in post intervention program. In addition the present study showed that, less than two thirds of the studied sample had poor compliance to self-care management during pre- intervention program, comparing to the majority of them had good compliance to self-care management during post- intervention program. More over the current study illustrated that, the minority of the studied sample had good practices regarding self-care management in pre- intervention program comparing to slightly less than two thirds of them in post intervention program.
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In addition the present study showed that, illustrated that, there are highly statistical significance differences between the studied sample knowledge and age, residence, educational level, occupation and caregiver of COPD adult patients’ in pre intervention program. There were statistical significance differences between the studied sample compliance to Self-Care management and age, residence, occupation and caregiver of studied patients in pre intervention program and there are statistical significance differences between the studied sample compliance to self-care management and their gender and occupation in post intervention program.
More over the present study showed that, there highly positive correlation between studied sample knowledge regarding COPD and their compliance to self-care management in pre intervention program. But there was a negative correlation between studied sample knowledge regarding COPD and their compliance to self-care management in post intervention program, there was a highly positive correlation between studied sample practices for self-care management and their compliance to self-care management in pre and post intervention program. Also there was a positive correlation between the studied sample knowledge regarding COPD and their practices for self-care management in post- intervention program.
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According to the findings it is recommended that;
1. Continuous intervention program for COPD patients with chronic obstructive pulmonary disease should be applied in chest outpatient clinics periodically in order to improve knowledge, practice and clinical outcomes for those patients.
2. Provide the community with the preventive information especially at the primary level about the COPD to increase the public‘s awareness about risk factors of COPD and its causes and healthy life style through the dissemination of mass media such as antismoking media, well balanced diet regime, physical exercise, continues follow up system, and others health promotion programs.
3. Further research to identify barriers that have been associated with poor compliance to self-care management.
4. Further research is recommended to identify the support that will help people self-managing and adapting to life with COPD to reduce the impact of this slowly progressive condition.