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Chronic Obstructive Pulmonary Disease Self-Management in Three LMICs: A Pilot Randomized Trial.

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dc.contributor.author Pollard, Suzanne L.
dc.contributor.author Siddharthan, Trishul
dc.contributor.author Hossen, Shakir
dc.contributor.author Rykiel, Natalie A.
dc.contributor.author Flores-Flores, Oscar
dc.contributor.author Alupo, Patricia
dc.contributor.author Quaderi, Shumonta
dc.contributor.author Ascencio, Ivonne
dc.contributor.author Barber, Julie A.
dc.contributor.author Chandyo, Ram
dc.contributor.author Kumar Das, Santa
dc.contributor.author Gianella Malca, Gonzalo Ernesto
dc.contributor.author Kirenga, Bruce
dc.contributor.author Grunstra, Kelli
dc.contributor.author Miranda, J. Jaime
dc.contributor.author Mohan, Sakshi
dc.contributor.author Ricciardi, Federico
dc.contributor.author Sharma, Arun K.
dc.contributor.author Shrestha, Laxman
dc.contributor.author Soares, Marta O.
dc.contributor.author Wosu, Adaeze C.
dc.contributor.author Hurst, John R.
dc.contributor.author Checkley, William
dc.date.accessioned 2023-10-09T17:09:16Z
dc.date.available 2023-10-09T17:09:16Z
dc.date.issued 2023
dc.identifier.uri https://hdl.handle.net/20.500.12866/14209
dc.description.abstract INTRODUCTION: Chronic obstructive pulmonary disease (COPD) disproportionately affects low- and middle-income countries (LMICs). Health systems are ill-prepared to manage the increase in COPD cases. METHODS: We carried out a pilot effectiveness-implementation randomized field trial of a community health worker (CHW)-supported, one-year self-management intervention in individuals with COPD grade B-D. The study took place in low-resource settings of Nepal, Peru, and Uganda. The primary outcome was the St. George's Respiratory Questionnaire (SGRQ) score at one year. We evaluated differences in moderate-to-severe exacerbations, all-cause hospitalizations and the EuroQol score (EQ5D-3L) at 12 months. RESULTS: We randomly assigned 239 participants (119 control, 120 intervention) with grade B-D COPD to a multi-component, CHW-supported intervention or standard of care and COPD education. 25 participants (21%) died or were lost to follow-up in the control arm compared to 11 (9%) in the intervention arm. At 12 months, there was no difference in mean total SGRQ scores between intervention and control arms (34.7 vs. 34.0 points; adjusted mean difference 1.0, 95% CI -4.2 to 6.1; p=0.71). The intervention arm had a higher proportion of hospitalizations (10% vs 5.2%; adjusted odds ratio 2.2, 95% CI 0.8-7.5; p=0.15) at 12 months compared to controls. CONCLUSION: A CHW-based intervention to support self-management of acute exacerbations of COPD in three resource-poor settings did not result in differences in SGRQ scores at one year. Fidelity was high, and intervention engagement was moderate. While results cannot differentiate between a failed intervention or implementation, it nonetheless suggests that we need to revisit our strategy. en_US
dc.language.iso eng
dc.publisher American Thoracic Society
dc.relation.ispartofseries American Journal of Respiratory and Critical Care Medicine
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject COPD en_US
dc.subject Self-management en_US
dc.subject Global Health en_US
dc.subject Community Health Workers en_US
dc.title Chronic Obstructive Pulmonary Disease Self-Management in Three LMICs: A Pilot Randomized Trial. en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1164/rccm.202303-0505OC
dc.relation.issn 1535-4970


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