Self-management and quality of life in chronic obstructive pulmonary disease (COPD): The mediating effects of positive affect

Patient Educ Couns. 2016 Apr;99(4):617-623. doi: 10.1016/j.pec.2015.10.031. Epub 2015 Nov 10.


Objective: This study aimed to increase our understanding of general self-management (SM) abilities in COPD by determining if SM can predict disease specific quality of life (QoL), by investigating whether specific SM domains are significant in COPD and by exploring the mediating effect of the positive/negative affect in the association between SM and QoL.

Methods: Cross-sectional study based on 292 patients with COPD. Measures included demographics, lung function, gait speed, health care utilization, positive/negative affect, SM abilities, breathlessness and disease specific QoL. We performed, correlation, multiple regression models and mediation analysis (positive/negative affect being mediator between SM and QoL association).

Results: After controlling for breathlessness, living alone, marital status, hospitalization history, age and lung function, SM related to QoL (p<0.0001). Investment in behaviors (hobbies and social relationships) and self-efficacy are SM domains independently related to QoL in COPD. Positivity measured by the positive/negative affect ratio completely mediates the relationship of SM with QoL.

Conclusion: SM is independently associated with disease specific QoL in COPD after adjustment significant covariates but positive/negative affect ratio completely mediates the relationship of SM with QoL.

Practice implications: Measuring positive/negative affect and addressing investment behavior and self-efficacy are important in implementing COPD-SM programs.

Keywords: COPD; Positive affect; Quality of life; Self-management.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Cross-Sectional Studies
  • Dyspnea / etiology
  • Dyspnea / physiopathology
  • Dyspnea / psychology
  • Female
  • Gait
  • Health Status*
  • Humans
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care
  • Patient Reported Outcome Measures
  • Pulmonary Disease, Chronic Obstructive / complications
  • Pulmonary Disease, Chronic Obstructive / physiopathology*
  • Pulmonary Disease, Chronic Obstructive / psychology*
  • Quality of Life*
  • Respiratory Function Tests
  • Self Care / psychology*
  • Self Efficacy*
  • Socioeconomic Factors
  • Surveys and Questionnaires