慢性阻塞性肺疾病患者戒烟的促进和阻碍因素的质性研究

A qualitative study of facilitators and hindrances of smoking cessation in patients with chronic obstructive pulmonary disease

目的了解慢性阻塞性肺疾病(COPD)患者戒烟的促进因素与阻碍因素,为COPD患者制订个性化的戒烟干预策略提供依据。方法以健康生态学理论为基础,采用质性研究中的现象学方法,目的抽样法选取2023年3—5月入住天津市第四中心医院的有吸烟史的15例COPD患者进行面对面的半结构式访谈。使用Colaizzi 7步分析法对访谈内容进行分析。结果共访谈15例COPD患者,其中男13例,女2例,年龄61~75岁。COPD患者戒烟的促进因素包括患有合并症、新型冠状病毒感染的后遗症、恐惧死亡、医护人员的戒烟宣教、家庭经济负担重、无烟环境;COPD患者戒烟的阻碍因素包括COPD的疾病症状较轻、尼古丁依赖程度较高、错误的疾病相关认知、家人的监督与管束、职业经历。结论COPD患者戒烟受到个人特质、行为特征、人际网络、生活和工作条件、政策环境5个层面因素的影响。医护人员、国家相关机构应针对COPD患者戒烟促进与阻碍因素制订相应的戒烟策略,以进一步降低COPD患者的吸烟率,促进患者健康,减轻疾病负担。

ObjectiveTo investigate the facilitators and hindrances of smoking cessation in patients with chronic obstructive pulmonary disease(COPD),and to provide a basis for developing individualized smoking cessation intervention strategies for COPD patients.MethodsBased on the health ecology theory and using a phenomenological approach in qualitative research,purposive sampling was used to select 15 COPD patients with smoking history who were admitted to Tianjin Fourth Central Hospital from March to May 2023 and face-to-face semi-structured interviews were conducted.Colaizzi seven-step analysis was used to analyze the interview content.ResultsA total of 15 COPD patients were interviewed,including 13 males and 2 females,aged 61-75 years old.The facilitators of smoking cessation in COPD patients included complications,sequelae of novel coronavirus infection,fear of death,smoking cessation counseling by medical staff,heavy family financial burden,and smoke-free environment.The hindrances of smoking cessation in COPD patients included milder disease symptoms of COPD,higher levels of nicotine dependence,false disease-related perceptions,family supervision and control,and occupational experience.ConclusionsSmoking cessation in COPD patients is influenced by five factors:personal characteristics,behavioral characteristics,interpersonal network,living and working conditions,and policy environment.Medical staff and relevant national institutions should formulate corresponding smoking cessation strategies according to address the facilitators and hindrances of smoking cessation in COPD patients,so as to further reduce the smoking prevalence of COPD patients,promote the health of patients and reduce the burden of disease.