Abstract
Background Chronic Obstructive Pulmonary Disease (COPD) is a progressive and debilitating condition that affects individuals' quality of life . COPD self-management and supports provided by carers is key to the quality of life people living with COPD. Health literacy (HL) and Patient Activation (PA) are main drivers of self-management practices (SMPs). However, their contribution remains to be fully explored. This study aimed to examine the level of self-management practices, and the relationship with socio-demographic factors, HL and PA among multi-morbid COPD patients from rural Nepal. Methods This is a cross-sectional study conducted between July 2018 and January 2019. Patients completed a survey, including Self-management Practices questionnaire (SMPQ), five domains of the Health Literacy Questionnaire (HLQ), and Patient Activation Measure (PAM). The relationship between HL, PAM, and self-management practice was examined using univariate statistics. Multivariable analysis was conducted to identify the factors associated with self-management practice. Results A total of 238 patients responded to the study. The mean score of SMPQ was 45.31(SD=9.00). The HLQ and PAM scores were positively correlated with the total score of SMPQ. Low level of SMPs were found to be positively associated with being uneducated (β=-0.43, p=.001), having a low family income (β=-5.22, p=.002), and, negatively associated with the presence of more than one co-morbidity (β=3.58, p=0.007) after controlling for other socio-demographic variables in the multivariable analysis. Conclusions The overall SMPs among this sample of Nepalese with COPD were low. Our findings highlight the need of implementation of self-management intervention program involving health literacy-focused activities for COPD, creating a support system for patients from low-income family and having low activation level.